Related Subjects:Acute Cholecystitis
|Acute Appendicitis
|Chronic Peritonitis
|Abdominal Aortic Aneurysm
|Ectopic Pregnancy
|Acute Cholangitis
|Acute Abdominal Pain/Peritonitis
|Assessing Abdominal Pain
|Penetrating Abdominal Trauma
|Acute Pancreatitis
|Acute Diverticulitis
Hypoglycaemic episodes are more serious in those with secondary diabetes due to pancreatitis as they lack the pancreatic hormone Glucagon as well as Insulin.
About
- Progressive damage to endocrine and exocrine function
- Irreversible and progressive scarring and fibrosis
- Exacerbations occur resembling acute pancreatitis
- It can be difficult to distinguish from pancreatic ca
Aetiology
- Alcohol in 70% (mean age 40 years)
- Idiopathic 20%
- Recurrent acute pancreatitis
- Hyperparathyroidism
- Hypertriglyceridaemia
- Pancreas divisum
- Autoimmune pancreatitis
- Tropical pancreatitis
- Post renal transplant
- Familial pancreatitis - autosomal dominant seen in 1-2% of cases
- Cystic fibrosis in children
Mechanism
- Damage leads to diabetes mellitus and exocrine pancreatic insufficiency.
- Inflammation and fibrosis cause chronic abdominal pain syndrome, metabolic bone disease, and pancreatic cancer
Types
- Chronic calcifying pancreatitis is commoner with precipitation of proteins in the ducts causing plugs and progressive scarring and destruction of acini with chronic inflammation. There is a loss of islets of Langerhans function with secondary diabetes. Abstention does not always slow disease progression.
- Chronic obstructive pancreatitis - strictures or stones blocking ducts can be treated surgically and improves
Clinical
- Recurrent severe epigastric and back pain eased by sitting forward
- Malabsorption - steatorrhea, Weight loss, cachexia and malnutrition
Complications
- Diabetes and Malabsorption
- Chronic pain and Malnutrition
- Opiate addiction
- Pancreatic pseudocysts
- Pancreatic calcification
- Pancreatic ductal adenocarcinoma
Investigations
- FBC - Anaemia. Raised WCC suggests infection
- Amylase may be normal or elevated and is of little use
- ↑ IgG (especially IgG4 in autoimmune pancreatitis)
- AXR - intraductal calcification
- ERCP or MRCP may be useful to look for treatable strictures or tumour or stones or pseudocysts. An increasing role for MRCP over ERCP
- CT scan - pancreatic cysts and calcium deposition
- Elevated blood sugar suggests secondary diabetes
- Malabsorption - faecal elastase-1
Management
- Admission and often opiate analgesia, Stop alcohol/smoking
- Pancreatic enzyme supplements for food digestion (Creon capsules) given with a PPI to reduce their inactivation
- Management of secondary diabetes mellitus
- Chronic pain management e.g. Coeliac plexus ganglion block can reduce pain. Can lead to problems managing opiate dependence.
- Longitudinal pancreaticojejunostomy helps pain if accompanied by abstention
- Dietician and nutritional support for malabsorption
- ERCP and sphincterotomy if pancreatic stones present or dilation and stenting of strictures as required
References