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