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ALL / Gastroenterology
Chronic pancreatitis
Chronic pancreatitis
Chronic pancreatitis is an inflammatory condition which can ultimately affect both the exocrine and endocrine functions of the pancreas. Around 80% of cases are due to alcohol excess with up to 20% of cases being unexplained.Other than alcohol, causes include:
- genetic: cystic fibrosis, haemochromatosis
- ductal obstruction: tumours, stones, structural abnormalities including pancreas divisum and annular pancreas
Features
- epigastric pain
- radiates to the back
- typically worse 15 to 30 minutes following a meal
- may be relieved by sitting forward
- steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain
- diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin
Investigation
- abdominal x-ray shows pancreatic calcification in 30% of cases
- CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%
- functional tests: faecal elastase may be used to assess exocrine function if imaging inconclusive
Multiple small calcific foci projected in the pancreas consistent with chronic pancreatitis
CT showing an irregular shaped pancreas with the typical calcification of chronic pancreatitis
Management
- pancreatic enzyme supplements
- analgesia
- antioxidants: limited evidence base - one study suggests benefit in early disease
+PassMedicine Notes
Chronic pancreatitis is an inflammatory condition which can ultimately affect both the exocrine and endocrine functions of the pancreas. Around 80% of cases are due to alcohol excess with up to 20% of cases being unexplained.
Other than alcohol, causes include:- genetic: cystic fibrosis, haemochromatosis
- ductal obstruction: tumours, stones, structural abnormalities including pancreas divisum and annular pancreas
- epigastric pain
- radiates to the back
- typically worse 15 to 30 minutes following a meal
- may be relieved by sitting forward
- steatorrhoea: symptoms of pancreatic insufficiency usually develop between 5 and 25 years after the onset of pain
- diabetes mellitus develops in the majority of patients. It typically occurs more than 20 years after symptom begin
- abdominal x-ray shows pancreatic calcification in 30% of cases
- CT is more sensitive at detecting pancreatic calcification. Sensitivity is 80%, specificity is 85%
- functional tests: faecal elastase may be used to assess exocrine function if imaging inconclusive
- pancreatic enzyme supplements
- analgesia
- antioxidants: limited evidence base - one study suggests benefit in early disease
