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Chronic pancreatitis (Complications (Chronic psuedocyst
Can be infected,…
Chronic pancreatitis
Complications
Chronic psuedocyst
Can be infected, obstruct, bleed/rupture
Drainage (endoscopic, percutaneous)
Surgical removal and reconstruction
Splenic vein thrombosis
Results in splenomegaly, portal HTN
Treat with distal pancreatectomy and splenectomy
Duodenal obstruction
Fibrosis, cyst, Ca
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Biliary obstruction
Oedema, cysts, fibrosis, Ca
Jaundice, cholangitis
May need reconstruction or stenting
GI bleeding
Treat with thrombosis, embolization,
distal pancreatectomy and splenectomy
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Pancreatic ascites
Pseudocyst or duct rupture
Nutrition, stenting, surgery
Malabsorption
Steatorrhoea, weight loss
Enzyme supplementation e.g. Creon
Pancreatic Ca
Surgical removal, stents, palliation
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Clinical
presentation
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Pain
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Associated symptoms
Steatorrhoea, DM, anorexia, weight loss
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Diagnosis
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Investigations
Bloods
Amylase, serum lipase (raised if acute-on-chronic)
Faecal elastase (exocrine enzyme marker; reduced)
Glucose (may be raised if DM)
Imaging
AXR (calcification)
USS/CT abdo (calcification, oedema, structure)
MRCP/EUS if unclear diagnosis
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Management
Definitive
Medical
Lipase (Creon) and fat-sol vitamin replacement (Multivite)
Analgesia (codeine, tramadol etc.)
Insulin (if DM)
Surgical
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Pancreatic
resection
Pancreaticodudenectomy (Whipple)
Indication: pancreatic head pathology e.g. cancer
Method: resect head, distal CBD, glaabladder and duodenum,
with pancreatico-jejunostomy/gastrostomy etc.
SE: DM, exocrine insufficiency, mortality
Distal pancreatectomy
Indication: distal pancreatic pathology
Method: may also remove spleen
SE: DM, exocrine insifficiency
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Pathophysiology
Trigger causes enzyme activation within pancreas
Proteins precipitate and calcify in ducts
Blockage causes inflammation and damage
Over time structural and functional change
Exocrine (digestive enzymes) and endocrine
(insulin, glucagon) failure