Chronic pancreatitis

Abdifatah Osman,MBBS,Mmed(General Surgery)

The traditional definition of chronic
pancreatitis has been permanent and
irreversible damage to the pancreas,
with histologic evidence of chronic
inflammation, fibrosis, and destruction
of exocrine (acinar cell) and endocrine
(islets of Langerhans) tissue.
• Diabetes mellitus or a history suggestive of
malabsorption (i.e., steatorrhea) indicates that
significant pancreatic endocrine or exocrine
function has been lost.

• and this is most compatible with the diagnosis

of chronic pancreatitis.
Diagnosis
• Tests Of Function • Tests of Structure
 Pancreatic Function Tests
• Steatorrhea – – A 72 hour fecal fat determination
– excretion of >7g fat per day
– Fecal Elastase more sensitive and specific
 Imaging
• Plain x-ray
• CT, MRI & USG
– Calcifications
– Ductal Dilatation
– Size of the pancreas
– Fluid collections
– MRCP is becoming the diagnostic test of
choice
 Treatment
• Conservative management
• Pain Management
• Cessation of alcohol
• Small meals, low in fat
• Hydration
• Cessation of smoking
• Pancreatic enzyme supplements

• Endoscopic treatment
 Surgery
• Patients who fail medical therapy
• Decompression or resection.
Pancreatic carcinoma
 Pathology
• Ductal adenocarcinoma accounts for about
85% of all neoplasms.
• And more than 95% of all pancreatic cancers
arise from the exocrine (digestive enzymes)
elements.
• Cancers that arise from the endocrine cells
(neuroendocrine, islet cells) account for 5% or
less
 Clinical features
• Tumor in the head
-Symptoms include unexplained episodes of
pancreatitis, painless jaundice, nausea,
vomiting, steatorrhea, and unexplained weight
loss.
• Patients with tumors arising in the neck, body,
or tail of the pancreas usually do not develop
jaundice or gastric outlet obstruction.

• Their symptoms may be limited to

unexplained weight loss and vague upper
abdominal pain until the tumor has grown
extensively and spread beyond the pancreas.
 Physical findings
• Liver nodules indicative of metastases can
sometimes be felt.
• Metastatic subumbilical (“Sister Mary Joseph
node”) and pelvic peritoneal (“Blumer's
shelf”) deposits,
• As well as left supraclavicular
lymphadenopathy (“Virchow's node”),
indicate the presence of distant metastases.
• A palpable gallbladder in a patient with
painless jaundice (i.e., Courvoisier's sign)
suggests the presence of a periampullary
neoplasm.
 Stages
• 1-4 stages
 Survival
• Survival Surgery offers the only cure but only
10-20% are candidates for resection and even
in this group the 5 year survival is only 20%
and the median 13 to 20 months
• Locally advanced the survival is 8 to 14
months
• Up to 60% already have metastases and a
median survival of only 4 to 6 months
 Treatment
• Surgical treatment

• Palliative treatment
• Pancreaticoduodenectomy (whipple
procedure) (pylorus-preserving Whipple or
standard Whipple) for carcinoma of the head
of pancreas.

• Distal pancreatectomy for carcinoma of the

tail and body of pancreas.
Distal pancreatectomy
Unresectable
• Obstructive jaundice?
• Thank you .