Chronic pancreatitis: Difference between revisions

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==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref>, <ref>Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206</ref>==
==Background==
* Pain
*Chronic imflammatory changes of the pancreas causing permanent structural damage
** Episodic (1wk) or constant
*Can be minimally symptomatic and presents with acute exacerbations.
** Epigastric, radiating to back and left infrascapular region
*Can lead to both long term endocrine and exocrine dysfunction
** Associated with nausea/vomiting
 
** Improved with sitting up or leaning forward
==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref><ref>Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206</ref>==
* Steatorrhea/DM
*[[Abdominal pain|Pain]]
** Late finding
**Episodic (1wk) or constant
** Requires >80-90% loss of exocrine and endocrine function
**Epigastric, radiating to back and left infrascapular region
* Erythema ab igne
**Associated with nausea/vomiting
** Hyperpigmentation of upper abdomen
**Improved with sitting up or leaning forward
*Steatorrhea/[[DM]]
**Late finding
**Requires >80-90% loss of exocrine and endocrine function
*Erythema ab igne
**Hyperpigmentation of upper abdomen


==Differential Diagnosis==
==Differential Diagnosis==
{{Abdominal Pain DDX Epigastric}}
{{Abdominal Pain DDX Epigastric}}


==Diagnosis==
==Evaluation==
* Labs
*Labs
** Lipase: Normal or slightly elevated
**Lipase: Normal or slightly elevated
** Increased bilirubin, alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
**[[LFTs]]: Increased [[Hyperbilirubinemia|bilirubin]], alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
** Pancreatic function tests: Secretin stimulation
**Pancreatic function tests: Secretin stimulation
** Gamma-globulin IgG elevation (IgG4) in autoimmune
**Gamma-globulin IgG elevation (IgG4) in autoimmune
* Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref>, <ref>Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.</ref>
*Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref><ref>Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.</ref>
** Plain film: pancreatic calcifications (30%)
**[[Abd xray|Plain film]]: pancreatic calcifications (30%)
** CT: intraductal calcifications (insensitive for early disease)
**CT: intraductal calcifications (insensitive for early disease)
** ERCP: gold standard  
**ERCP: gold standard  
 
==Management==
*Lifestyle modifications (alcohol and tobacco cessation), dietary changes
*Pancreatic enzyme supplements
*Acid suppression ([[H2 antagonist]], [[PPI]])
*[[analgesia|Analgesics]] ([[NSAIDs]], [[opioids]], [[pregabalin]])
*Specialist referral for refractory pain


==See Also==
==See Also==
[[Pancreatitis]]
*[[Pancreatitis]]
[[Pancreatitis Guidelines]]
*[[Pancreatitis Guidelines]]


==References==
==References==

Revision as of 19:51, 29 September 2019

Background

  • Chronic imflammatory changes of the pancreas causing permanent structural damage
  • Can be minimally symptomatic and presents with acute exacerbations.
  • Can lead to both long term endocrine and exocrine dysfunction

Clinical Features[1][2]

  • Pain
    • Episodic (1wk) or constant
    • Epigastric, radiating to back and left infrascapular region
    • Associated with nausea/vomiting
    • Improved with sitting up or leaning forward
  • Steatorrhea/DM
    • Late finding
    • Requires >80-90% loss of exocrine and endocrine function
  • Erythema ab igne
    • Hyperpigmentation of upper abdomen

Differential Diagnosis

Epigastric Pain

Evaluation

  • Labs
    • Lipase: Normal or slightly elevated
    • LFTs: Increased bilirubin, alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
    • Pancreatic function tests: Secretin stimulation
    • Gamma-globulin IgG elevation (IgG4) in autoimmune
  • Imaging[3][4]
    • Plain film: pancreatic calcifications (30%)
    • CT: intraductal calcifications (insensitive for early disease)
    • ERCP: gold standard

Management

See Also

References

  1. Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1
  2. Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206
  3. Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4
  4. Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.