Chronic Pancreatitis dilatation  Endoscopic U/S

Tests of pancreatic function

Chronic inflammatory disease characterized by fibrosis and destruction of  OGTT  Pancreolauryl or PABA test
exocrine pancreatic tissue. DM may occur as a complication  Faecal pancreatic chymotrypsin or  Collection of pancreatic juice after
elastase secretion injection (gold std but invasive
and seldom done)
Causes Tests of anatomy prior to surgery
 Alcoholism (70-80%) – commonest  Pancreatic divisum (failure of fusion of  ERCP
cause primitive dorsal &ventral ducts – most of
 Obstructive eg stenosis of ampulla of pancreatic drainage occurs through the
Complications
Vater, pancreatic tumours, gallstones smaller accessory ampulla instead
 Haemochromatosis which is prone to restriction)  Pseudocysts  Extrahepatic obstructive jaundice – due
 Cystic fibrosis  Idiopathic  Pancreatic ascites to benign stricture of the CBD as it
 Duodenal stenosis passes through the diseased pancreas
 Hereditary  Portal / splenic vein thrombosis – leads
 Peptic ulcer
to segmental portal hpt & gastric
Pathophysiology varices

Protein rich viscous Ppt to form Obstruction Management

pancreatic juice plugs of ducts Alcohol abuse Counseling & psychiatric intervention
Pain relief Analgesics May lead to opiate addiction
Alcohol Oral pancreatic enzyme Suppress pancreatic secretion and pain, thus
supplements sparing analgesics
 secreation of pancreatic Calcification Endoscopic therapy  Dilatation or stenting of main pancreatic duct
stone inhibitors  Removal of calculi (mechanical or shockwave
Progressive acinar lithotripsy)
ectasia & atrophy Surgical therapy  Partial pancreatic resection
 Pancretico-jejunostomy
 Total pancreatectomy: if no correctable abN
Pancreatic insufficiency is found – but causes DM and high risk of
hypoglycaemia. Significant mortality and
Clinical features morbidity
 Middle-aged alcoholics  Diarrhoea / steatorrhoea Steatorrhoea Oral fat restriction
 Presents either as acute exacerbations  LOW – due to anorexia, food avoidance Oral pancreatic enzyme supplements
or slowly progressive chronic pain w/o due to postprandial pain, malabsorption Proton pump inhibitor Optimize duodenal pH for pancreatic enzyme
acute exacerbations &/or diabetes activity
 Abdominal pain relieved by leaning  Protein malabsorption Diabetes Diet & insulin therapy
forward or drinking EtOH  Diabetes Management Surgical or endoscopic Rx For pseudocysts, pancreatic ascites, CBD or
 Epigastric tenderness  Featuers of alcohol / smoking related of Cxs duodenal stricture and portal HPT
 A/w chronic analgesic consumption diseases

Investigations
Tests to establish diagnosis
 U/S – dilated biliary tree, gallstones  AXR – pancreatic calcifications
 CT scan – calcifications, atrophy, ductal  ERCP

DGIM – Last updated March 2005