Chronic Pancreatitis -Jenkins

Question 1

What is a key symptom in chronic pancreatitis?

Answer 1

pancreatic insufficiency:

• can’t digest complex food –> steatorrhea and diarrhea and deficiency in fat soluble vitamins and B12
• can’t produce insulin –> pancreatic diabetes
• can also present with abd pain, radiating to back with n/v, worse after eating and better with leaning forward
• -> this pain lasts < 10 days with pain free intervals of months–> years

Question 2

Which 2 diagnoses can lead to chronic pancreatitis?

Answer 2

Cystic fibrosis, SLE

Question 3

What is the triad in the late stages of chronic pancreatitis?

Answer 3

Steatorrhea, diabetes, calcifications of the pancreas (can be seen on CT or plain film)

Question 4

What is the cause of type 1 DM?

Answer 4

1=autoimmune

can also be from chronic pancreatitis and pancreatectomy

Question 5

What can ERCP show? What will this look like in chronic pancreatitis?

Answer 5

abnormal pancreatic duct

-beading of pancreatic duct and ecstatic side branches in chronic pancreatitis

Question 6

What are pancreatic function tests for? How is this done?

Answer 6

diagnosing pancreatic insufficiency

• can diagnose early chronic pancreatitis without radiographic findings
• stimulate the pancreas with a meal and analyze the duodenal fluid of pancreatic secretory contents

Question 7

What is the treatment for chronic pancreatitis?

Answer 7

• Stop alcohol consumption for alcoholic pancreatitis
• Small meals
• Pancreatic Enzyme Supplements
• pain management

Question 8

What lab test is used for diagnosis of autoimmune pancreatitis? is this more acute or chronic?

Answer 8

IgG

this is more acute

Question 9

What is the cause of 80% of chronic pancreatitis?

Answer 9

alcohol abuse

Question 10

What is the pathogenesis of chronic pancreatitis?

Answer 10

Increased secretion of GP2 without increase in bicarb secretion ==> formation of plugs –> calcification ===> stone formation –> scarring and obstruction

Question 11

What are the amylase and lipase levels in chronic pancreatitis?

Answer 11

normal –> slightly elevated

Question 12

Which labs will be elevated in chronic pancreatitis?

Answer 12

• serum bilirubin and alk phos

- can have autoimmune markers /autoantibodies (antilactoferrin, anti carbonic anhydrase II)

Question 13

What 2 genetic testings can be done in chronic pancreatitis?

Answer 13

CFTR gene

CTRC gene (chymotrypsinogen C) –> protective of the pancreas by eliminating prematurely activating trypsin *mutated more in chronic pancreatitis