Pancreatitis - chronic Flashcards
1
Q
What is chronic pancreatitis?
A
- Chronic fibro-inflammatory disease of pancreas
- = progressive and irreversible damage to pancreatic parenchyma
2
Q
Presentation of chronic pancreatitis
A
- Chronic abdominal pain
- May also develop: malabsorption, diabetes mellitus
3
Q
Main causes of chronic pancreatitis
A
- Chronic alcohol abuse
- Idiopathic
4
Q
Other causes of chronic pancreatitis
A
- Metabolic - hyperlipidaemia, hypercalcaemia
- Infection - viral eg HIV, mumps and coxsackie and bacterial eg echinococcus
- Hereditary - cystic fibrosis
- Autoimmune - pancreatitis or SLE
- Anatomical - malignancy, stricture
- Congenital anomaly - divisum or annular
5
Q
Symptom of chronic pancreatitis
A
- Chronic pain - complicated by recurring attacks of acute pancreatitis
- Pain is in epigastrum and back
- Associated with N+V
- May also present with endocrine or exocrine insufficiency
6
Q
Endocrine insufficiency presentation of chronic pancreatitis
A
- Secondary to damage of endocrine tissue of pancreatic gland - islets of Langerhans
- Failure to produce insulin - impaired glucose regulation and diabetes mellitus
7
Q
Exocrine insufficiency chronic pancreatitis presentation
A
- Secondary to damage to acinar cells
- Failure to produce digestive enzymes –> malabsorption
- Presents with weight loss, diarrhoea or steatorrhoea
8
Q
Examination findings for chronic pancreatitis
A
- Soft abdomen
- Tender epigastric region
- Cachexia
9
Q
What can occur due to reccurent attacks of acute pancreatitis in chronic pancreatits?
A
- Pseudocyst present
- May present with mass effect eg biliary obstruction or gastric outlet obstruction
10
Q
Bedside and bloods for ?chronic pancreatitis
A
- Urine dip
- Routine bloods - FBC, CRP, LFTs
- Serum amylase/lipase often NOT raised in established disease
- Blood glucose
- Faecal elastase - low in most cases with exocrine insufficiency alonside (secreted from pancreas)
11
Q
Imaging for ?chronic pancreatitis
A
- CT abdomen - pancreatic atrophy or calcification, any causes may also be seen eg malignancy
- USS or MRCP for anatomy of pancreas and biliary tree
12
Q
Special tests for ?chronic pancreatitis
A
- Secretin stimulation test
- Endoscopic US (EUS)
Use if uncertain from other tests
13
Q
Management for chronic pancreatitis
A
- Treat underlying cause - eg alcohol cessation, statins for high cholesterol
- Analgesia is mainstay of treatment
- Exocrine dysfunction - enzyme replacement (eg Creon) and fat soluble vitamin supplementation (ADEK)
- Check bone density routinely
- Diabetes - insulin regimes
- Steroids if autoimmune
14
Q
Best analgesia for chronic pancreatits
A
- In acute flares, follow WHO analgesic ladder
- For chronic, opioid not often effective
- Neuropathic analgesia eg Pregabalin is often more effective
15
Q
Non-pharmacological analgesia options chronic pancreatitis
A
- Endosonography guided celiac plexus blockade
- Thoracoscopic splanchnicetomy
- BUT dissapointing long term effects despite short term relief
18
Q
Surgical management of chronic pancreatitis
A
- Freys - large ductal stone or pancreatic head disease, coring out diseased part of pancreatic head, formation of pancreaticojejunostomy - allows better drainage of pancreatic duct into jejenum
- Whipples - pancreaticoduodenectomy if pancreatic head malignancy
