Chronic pancreatitis

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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.