Chronic pancreatitis

Chronic pancreatitis

Compared to acute– Maybe painless, normal amylase and lipase, mononuclear infiltrate and fibrosis

TIGARO– Toxin(ethanol, hypercalcemia, hyperlipidemia, acidosis, CRF), idiopathic, Genetic, autoimmune(Sjogren, IBD, PBC), Recurrent acute, Obstructive

Etiology– alcohol, smoking, hereditary pancreatitis(before 20yrs old), ductal obstruction, tropical pancreatitis, systemic(cystic fibrosis, SLE), CFTR, SPINK1, PRSS1, 

Presentation– pain(after meal 15~30mins), steatorrhea>protein deficiency, pancreatic diabetes(alpha and beta cell was destroyed, maybe hyloglycemia)

Diagnosis– triad of calcification, steatorrhea, DM

Pancreatic function test– Lundh test(after standard meal), secretin test(IV secretin)

DDx– Pancreatic cancer, autoimmune pancreatitis, lymphoma, pancreatic endocrine tumor

CT/MRI/US- calcification, ductal dilation, pancreas enlarged, fluid collection, atrophy

If normal image→ secretin pancreatic function test, ultrasound

Treatment:

1.Quit smoking and alcoholing

2.small meal with low fat, hydration

3.Analgelsic(amitriptyline, nortriptyline, morphine)

4.Pancreatic enzyme supplementation with PPI/H2 blocker, fat<20g/day, fat soluble vitamin, monitor calcium, medium chain triglyceride(MCT)

Complication:

1.Pseudocyst-Asymptomatic, maybe abdominal pain, duodenal or biliary obstruction, vascular occlusion, or fistula formation into adjacent viscera, infection with abscess, Digestion of an adjacent vessel can result in a pseudoaneurysm, pancreatic ascites and pleural effusion

2.Bile duct or duodenal obstruction- postprandial pain and early satiety, weight loss, jaundice

3.Pancreatic ascites and pleural effusion- high amylase, octreotide can reduce pancreatic stimulation

4.Pseudoaneurysm- blood into pseudocyst/peritoneal cavity

5.Splenic vein thrombosis- gastric varices without esophageal varices

6.Pancreatic diabetes/calcification/cancer

Published by Steve Johnson

I am a doctor who like to organise knowledges and share ideas with others. As a doctor, a lot of knowledges influx everyday and need some patient to organise and absorb. Here was my notes to share with you and hope to save your time to know it.

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