Saturday, 10 April 2010

Chronic Pancreatitis

"sustained inflammation of the pancreas associated with irreversible morphological changes & loss of function"

Epidemiology
10/100 000 Western population
50s

Presentation
Abdominal pain
Maldigestion
DM
Jaundice

Aetiology
40% unknown
Chronic alcoholism
Hupercalcaemia
Huperlipidaemia
CF
Biliary disease
Genetic Fx (rare AD hereditary pancreatitis) - predisposes to pancreatic cancer

Pathogenesis
Duct plugging from abnormal secretion/repeated inflammation & repair fibrosis =
Gland distortion =
Increased risk pancreatitis
(necrosis-fibrosis-cycle)
*stimulus remains (e.g. alcoholism)

Pathology
Pancreas enlarged
Septal fibrosis
Intra-P fat necrosis
Advanced Disease
Shrunken, firm pancreas
Extensive fibrosis
Calcification
Variable dilatation of Pc ducts
Pseudocysts common

Micro Fx
Fibrosis
Loss of exocrine glands
Chronic inflammation (lymphocytes/plasma cells & monocytes)

Cx
70% Local
Biliary/duodenal/colonic obstruction
Pseudocysts
Haemorrhage
Pancreatic ascites
Gastric varices

*2ry DM (islet damage)
*Malabsorption (acinar damage)

Increased risk of pancreatic carcinoma (confounded by alcohol & smoking)

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