1 Page Notes : Chronic Pancreatitis

Chronic Pancreatitis – Fibrosis + destruction of exocrine pancreatic tissue. DM occurs in advanced cases because islets of Langerhans involved. Pathophysiology Alcohol | Protein rich, viscous pancreatic juice | Precipitation to form plugs Alcohol | | Obstruction of ductules Decrease secretion of lithostatin  Calcification + glandular ischaemia | Progressive acinar ectasia and atrophy  Pancreatic insufficiency •

Southern India – Non alcoholics. Possibly result of malnutrition + cassava consumption.

Other causes :

1. Calcific – Alcoholism, Tropical (India) 2. Obstructive – Stenosis of ampulla of Vater. 3. Pancreas divisum, CF, Hereditary, Idiopathic.

Clinical Features: (middle aged alcoholic men) 1. Abdominal pain – combination of increased pressure of duct + involvement of nerves by the inflammatory process. Relieved by leaning forward/drinking alcohol. May present as acute pancreatitis (50%), slowly progressive chronic pain without acute exacerbation (30%), no pain and just diarrhoea. 1/5 chronically consume opiate analgesics. 2. Weight loss  Anorexia, avoidance of food (post-prandial pain), malabsorption, and/or diabetes. 3. Steatorrhoea – if > 90% exocrine tissue destroyed 4. Protein malabsorption – only in most advanced cases * overall, 30% diabetic  70% having chronic calcific pancreatitis. Physical exam: 1. Thin, malnourished with epigastric tenderness 2. Skin pigmentation over abdomen & back. Chronic use of hot H2O bottle 3. Features of alcoholism & smoking. Complications: 1. Pseudocysts & pancreatic ascites 2. Extrahepatic obstructive jaundice 3. Duodenal stenosis 4. Portal/ splenic vein thrombosis leading to segmental portal HTN + gastric varices 5. Peptic ulcer Management: 1. Alcohol misuse 2. Pain relief 3. Steatorrhoea

4. Complications – Surgical/endoscopic therapy

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