Chronic Pancreatitis

Chronic Pancreatitis

·        = Replacement of pancreatic tissue by fibrosis, often with calcification, sometimes with duct dilation and stones

·        May result in chronic pain, relapsing acute pancreatitis, exocrine or endocrine deficiency

Causes:

·        Alcohol (60 – 80%) ® duct obstruction by protein rich secretions

·        Obstruction (10%)

·        Idiopathic (10%)

·        Genetic factors

·        Hypercalcaemia and Hyperlipidaemia

·        Congenital anomalies of duct

·        Following acute pancreatitis of any cause

Symptoms

·        Abdominal pain, weight loss, diarrhoea/steatorrhoea, diabetes mellitus (late complication – islet cells are the last to fail), acute pancreatitis

Investigations

·        As for acute, plus check chronic differentials (e.g. ulcer, GORD)

·        Blood glucose, GTT

Pathology

·        Chronic calcifying pancreatitis:

o  In alcoholics

o  Macroscopic appearance: throughout lobules of pancreas, hardened foci of calcification 

o  Microscopic appearance: atrophy of acini, fibrosis, chronic inflammation. Dilated ducts and atrophic epithelium

·        Obstructive pancreatitis

o  Due to cholelithiasis

o  Affects periductal regions, mainly head of the pancreas

o  Ductal epithelium better preserved

Treatment:

·        Exocrine/endocrine replacement

·        Analgesia

·        Surgery: duct dilation, resection of diseased portion