Chronic pancreatitis Flashcards
What is chronic pancreatitis?
chronic fibro-inflammatory disease of the pancreas with progressive and irreversible damage of pancreatic parenchyma
What are the causes of chronic pancreatitis?
Chronic alcohol abuse, idiopathic, hyperlipidaemia, Hupercalcaemia, viral or bacterial cause, cystic fibrosis, autoimmune, sLE, Stricture formation, neoplasm, pancreas divisum, annular pancreas
What is large duct disease in chronic pancreatitis?
there is dilatation and dysfunction of the large pancreatic ducts, therefore visible on most diagnostic imaging. The pancreatic fluid changes composition and facilitates the deposition of precursors to calcium carbonate stones and causes diffuse pancreatic calcification. This subtype is more commonly found in males.
What is small duct disease in chronic pancreatitis?
usually associated with normal imaging and no pancreatic calcification, making it difficult to diagnose. It is predominantly found in females.
What are the risk factors for chronic pancreatitis?
Excess alcohol, smoking, pancreatic malignancy
What are the clinical features of chronic pancreatitis?
chronic pain, epigastrium and radiates to the back, feels better leaning forward nausea and vomiting, diabetes mellitus and steatorrhoea, and malabsorption
What would be present on physical examination of chronic pancreatitis?
unremarkable but may have epigastric tenderness on palpation, may feel mass if pseudocyst or inflammatory mass present
What are the differential diagnosis of chronic pancreatitis?
Acute cholecystitis, peptic ulcer disease, acute hepatitis, sphincter of oddi dysfunction
What investigations would you do for chronic pancreatitis?
BM to check for raised glucose, serum calcium to assess for hypercalcaemia, LFTs abnormal, amylase and lipase aren’t usually significantly raised, faecal elastase would be low
What imaging would you do for chronic pancreatitis?
Abdominal USS, CT abdomen pelvis scan, MRCP, ERCP
What is the initial management for chronic pancreatitis?
analgesia and complications addressed, pancreatic enzyme supplement
What is the definitive management for choric pancreatitis?
avoid alcohol, management of chronic pain, nutritional support, endoscopic surgical management, to take out stones, steroids
What surgery can be done for chronic pancreatitis?
Lateral pancreaticojejunostomy, pancreaticoduodenoectomy and total pancreatectomy
What are some complications of chronic pancreatitis?
Psuedocust, steatorrhoea, malabsorption, diabetes, effusions, pancreatic malignancy
