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GI and General surgery > Chronic Pancreatitis > Flashcards

Chronic Pancreatitis Flashcards

1
Q

What is chronic pancreatitis?

A

Continuing inflammatory disease of the pancreas characterised by irreversible glandular destruction and typically causing pain and/or permanent loss of function

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2
Q

What is the pathogenesis of chronic alcoholic pancreatitis?

A

Chronic alcoholic pancreatitis is characterised by dilated pancreatic ducts filled with protein plugs which may be calcified due to impaired calcium regulation. This leads to atrophy of the acinar tissue and fibrosis with relative preservation of islets.

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3
Q

What are causes of chronic pancreatitis?

A
  • Alcohol
  • Smoking
  • Autoimmune
  • Familial
  • CF
  • Haemochromatosis
  • Pancreatic duct obstruction
  • Congenital - pancreas divisum
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4
Q

What is autoimmune pancreatitis?

A

IgG4-related disorder where the immune system attack the pancreas. There are two types; Type 1 and type 2

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5
Q

What are well recognised susceptibility genes implicated in chronic pancreatitis?

A
  • PRSS1
  • SPINK1
  • CFTR
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6
Q

What are symptoms of chronic pancreatitis?

A
  • Epigastric pain boring through to the back - relieved by sitting forward or hot water
  • Bloating
  • Steatorrhoea
  • Weight loss
  • Brittle diabetes
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7
Q

What signs might be seen in chronic pancreatitis?

A
  • Weight loss
  • Erythema ab ignes
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8
Q

What is erythema ab ignes?

A

Erythema caused by exposure to heat - in the context of chronic pancreatitis

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9
Q

What investigations would you consider doing in someone with suspected chronic pancreatitis?

A
  • Bloods - Serum amylase/lipase, albumin, Ca2+, vit B12, LFTs, Prothrombin time, glucose
  • Ultrasound +/- CT
  • Faecal elastase
  • MRCP/ERCP
  • EUS
  • AXR
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10
Q

What differential diagnosis would you consider in someone with features of chronic pancreatitis?

A

Pancreatic malignancy

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11
Q

What features are you looking for in Endoscopic ultrasound/CT scan?

A

Pancreatic calcification

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12
Q

How would you manage someone with chronic pancreatitis?

A
  • Analgesia
  • Pancreatic enzyme replacement - Creon
  • Insulin
  • Dietary advice
  • Surgery
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13
Q

What dietary advice would you give someone with chornic pancreatitis?

A
  • No alcohol
  • Low fat diet
  • Medium chain triglycerides
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14
Q

What are options for pain relief in chronic pancreatitis?

A
  • Opiates - dihydrocodeine, pethidine
  • Coeliac plexus block
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15
Q

What surgical procedures are used for unremitting pancreatic pain?

A
  • Pancreatectomy
  • Pancreaticojejunostomy
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16
Q

What are complications of chronic pancreatitis?

A
  • Pseudocyst
  • Diabetes
  • Biliary obstruction
  • Local artery aneurysm
  • Splenic vein thrombosis
  • Gastric varices
  • Pancreatic carcinoma

GI and General surgery (44 decks)

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