l34 chronic pancreatitis st

Chronic Pancreatitis

Lecture 34

• The chief distinction between acute and chronic pancreatitis is the

irreversible impairment in pancreatic function that is characteristic of chronic pancreatitis.

Causes90% 0r 2/3

Causes of chronic pancreatitis

Gallstones, HyperparathyroidismCongenital malformation

PancreasDivisum

Annular Pancreas

Pathogenesis

Pathogenesis

Pathogenesis1 2

3

Not well understood

Almost all individuals with repeated episodes of acute pancreatitis later develop chronic pancreatitis.

Events in Pathogenesis

PathogenesisMediators In Chronic Pancreatitis

monocyte chemoattractant protein.

Profibrogenic Cytokines

Stellate cells

Morphology

Atrophy

Fibrosis

Dilation

Chr. Infiltrate

Morphology

Morphology

Lymphoplasmacytic Sclerosing Pancreatitis (Autoimmune Pancreatitis)

Chronic pancreatitis. A, Extensive fibrosis and atrophy has left only residual islets (left) and ducts (right), with a sprinkling of chronic inflammatory cells and acinar tissue. B, A higher power view demonstrating dilated ducts with inspissated

eosinophilic ductal concretions in a person with alcoholic chronic pancreatitis.

Clinical features

abdominal pain:– may be continuous, intermittent or absent– Pattern is often atypical

• RUQ or LUQ of the back• Diffuse throughout upper abdomen• May be referred to the anterior chest or flank

– Typical form:• Persistent , deep-seated,• Unresponsive to antacids• Worsened by alcohol intake or a heavy meal (especially fatty foods)• Often need narcotics

• Pancreatic insufficiency– Weight loss– Fat malabsorption: • Steatorrhea: 15% of patients present with steatorrhea

and no pain– Pancreatic diabetes:• Like DM1 needs insulin , but risk of hypoglycemia is

more than it (because alfa cells is also affected– Fat-soluble vitamin deficiency rare

Diagnosis

Complications

• pseudocyst formation• bile duct or duodenal obstruction• pancreatic ascites or pleural effusion• splenic vein thrombosis• Pseudoaneurysms• pancreatic cancer • acute attacks of pancreatitis( particularly alcoholics

who continue drinking)

Treatment