Chronic pancreatitis

• Chronic inflammatory disease characterised by fibrosis and destruction of pancreatic tissue
• Epigastric pain bores through to the back – it is relieved by sitting forward and hot water bottles so look for erythema ab igne (mottled dusky greyness)
• Associated with pain, exocrine and endocrine pancreatic insufficiency;
  • Bloating
  • Steatorrhoea
  • Weight loss
  • Brittle diabetes

Causes

• Alcohol – predominantly occurs in alcoholic middle aged men
• CF
• Haemochromatosis
• Familial causes
• Pancreatic duct obstruction – stones, tumour

Tests

• Faecal elastase of chymotrypsin
• Ultrasound
• CT, ERCP, MRCP
• AXR – speckled pancreatic calcification

Treatment

• Give analgesics
• Lipase
• Insulin
• Diet – medium chain triglycerides may be tried as these don’t require lipase for digestion. No alcohol
• Surgery

Complications

• Pseudocyst
• Biliary obstruction
• Local arterial aneurysm
• Splenic vein thrombosis
• Gastric varices