Chronic pancreatitis Causes Symptoms Diagnosis and Treatment

Chronic pancreatitis Diseases Symptoms Diagnosis and Treatment

Chronic pancreatitis Pregentation

  • · Abdominal pain
  • · Steatorrhea.

A form of pancreatitis that results from repeated or massive pancreatic injury, marked by the formation of scar tissue, which leads to malfunction of the pancreas

  • Irreversible:
  • Progressive destruction of the pancreas
  • Results in both exocrine and endocrine deficiencies
  • Pain, maldigestion, and diabetes mellitus (DM) are the major features.

Chronic pancreatitis

Chronic pancreatitis Causes Symptoms Diagnosis and Treatment


Chronic pancreatitis Causes

  • · Alcoholism
  • · Cystic fibrosis
  • · Genetic disease
  • · Autoimmune.

Chronic pancreatitis Clinical Features

  • Chronic pancreatitis typically presents as chronic unrelenting pain with episodic flares,
  • Pain in abdomen may be continuous, intermittent or absent
  • · Atypical pain, back pain, diffuse pain, chest pain or flank pain.
  • · Persistent, deep-seated pain.
  • · Pain after alcohol or heavy meal.
  • · Weight loss.
  • · Stools abnormal like malabsorption.
  • · Abdominal tenderness.
  • · Fever.

Diagnostic Tests and Interpretation

  • Chronic pancreatitis:
  • Tests sometimes normal
  • Hyperglycemia
  • Steatorrhea
  • Flare-ups may mimic acute pancreatitis.
  • Elevated alkaline phosphatase, bilirubin
  • Hereditary pancreatitis: Mutations in PRSSI gene and SPINKI gene
  • Autoimmune pancreatitis: Elevated serum IgI, autoantibodies to lactoferrin and carbonic anhydrase
  • Chronic pancreatitis Differential Diagnosis :
    • Pancreatic cancer
    • Other malabsorptive processes
    • •Other cause of biliary obstruction
    • Disorders that may alter results:
  • Biliary tract disease
  • Penetrating peptic ulcer
  • Intestinal obstruction
  • Intestinal ischemia/infarction
  • Ruptured ectopic pregnancy
  • Renal insufficiency
  • Burns
  • Macroamylasemia, macrolipasemia

Chronic pancreatitis Diagnosis

  • · Serum amylase and lipase may not be elevated.
  • · Alkaline phosphatase levels increased.
  • · Fasting hyperglycemia.
  • · Triad of pancreatic calcification, steatorrhea and diabetes mellitus.
  • · Decreased serum trypsinogen less than 20 ng/ ml, fecal elastase less than 100 I-lg/mg of stool.
  • · X-ray – scattered calcification.
  • · Ultrasound, CT and ERCP.
  • Radiograph of abdomen: Pancreatic calcification
  • Ultrasound and/or CT scan of abdomen: Pseudocyst formation/calcification
  • ERCP/MRCP: Ductal deformity, retained common bile duct stone, pancreatic duct stones, and strictures
  • Endoscopic ultrasound
Chronic pancreatitis Complications
  • · Cobalamin malabsorption (812 deficiency) in alcoholic and cystic fibrosis.
  • · It is corrected by giving pancreatic enzymes.
  • · Diabetes mellitus, diabetic ketoacidosis
  • · Pleural effusion
  • · Pericardial effusion
  • · GI bleeding
  • · Portal vein thrombosis
  • · Jaundice
  • · Incidence of pancreatic carcinoma is increased.

Chronic pancreatitis Prognosis

  • Acute pancreatitis: 85–90% resolve spontaneously; 3–5% mortality (17% in necrotizing pancreatitis). APACHE II scoring is most accurate but difficult to apply
  • Ranson criteria (see below) have a sensitivity of ~40%.
  • On admission: Age >55 years, WBCs >16,000/mm, blood glucose >200 mg/dL (11.1 mmol/L), serum lactate dehydrogenase (LDH) >350 IU/L, AST >250 IU/L.
  • Within 48 h: hematocrit decreases >10%, serum calcium <8 mg/dL, blood urea nitrogen (BUN) increase >8 mg/dL, arterial PO2 <60 mmHg, base deficit >4 mEq/L, fluid retention >6 L

Chronic pancreatitis Treatment

    • Ensure alcohol abstinence.
    • Persistent elevation of amylase weeks after acute pancreatitis suggests possibility of pseudocyst; perform imaging study.
    • Avoid alcohol No fats
    • Pain killers – narcotics
    • Surgical interference – resection of pancreas Nerve blocks

Chronic pancreatitis:

  • Analgesics
  • Pancreatic enzyme supplements (Pancrease MT, Creon)

 

  • H2 blockers (reducing gastric acid, increases availability of pancreatic enzymes)
  • Pancreatic enzymes
  • H2 receptor antagonist Sodium bicarbonate Proton pump inhibitors
  • Antacids – Calcium carbonate, magnesium hy­droxide
  • Supportive measures.
  • Chronic pancreatitis—pain: Pseudocyst drainage
  • Diet

 

    • Acute pancreatitis: Begin diet after pain, tenderness, and ileus have resolved; small amounts of high-carbohydrate, low-fat, and low-protein foods; advance as tolerated; NPO or nasogastric tube if patient is vomiting
    • Total parenteral nutrition (TPN) if oral is not tolerated (no lipids if triglycerides are increased)
    • Enteral nutrition preferable to TPN if tolerated (less infection, decreased organ failure)
    • Give oral pancreatic enzymes if necrotizing pancreatitis.
    • Chronic pancreatitis: Small meals high in protein; adjust if DM is present.
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