Updated: 12/24/2018

Chronic Pancreatitis

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  • A 52 year-old male, with a twenty-year history of alchoholism presents to the ER with persistant epigastric pain, constipation, and steatorrhea. His labs are remarkable for an elevated amylase and lipase. Abominal radiograph shows a mild ileus. CT scan demonstrastes dystrophic calcifications of the pancreas.
Introduction
  • Caused by obstruction and dysfunction of the pancreatic system leading to
    • fat soluble vitamin deficiency 
    • diabetes mellitus
    • poor absorption of dietary fats
  • Caused by repeated bouts of acute pancreatitis
    • follows a persistant and recurrent disease course
  • Risk factors
    • alcoholism
    • cystic fibrosis
  • Associated with ↑ risk of pancreatic cancer
Presentation
  • Symptoms
    • persistant epigastric pain
    • constipation
    • flatulance
    • steatorrhea 
      • due to lack of lipase
Evaluation
  • Labs
    • commonly normal amylase and lipase
    • glucosuria
  • Imaging
    • CT
      • dystrophic calicifications
      • mild ileus
      • dilations of pancreatic duct
        • "chain-of-lakes" appearance
      • psuedocysts
  • Pancreatic function tests
    • secretin stimulation
    • bentiromide test
      • evaluates function of pancreatic chymotripsin
      • oral bentiromide can be cleaved by chymotripsin to a substance that can be detected in urine
Treatment
  • Lifestyle modifications with medical management
    • alchohol cessation
    • low fat diet
      • avoids pancreatic stimulation
    • oral pancreatic enzymes
      • lipase before, during, and after meals
      • concurrent administration of histamine antagonist to reduce acidity
        • will inactivate enzyme
    • analgesia for pain
  • Pancreatectomy only if intractable pain despite medical therapy
 

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