2. DEFINITION
Ongoing inflammatory and fibrosing Disorder.
Irreversible morphologic changes.
Progressive and permanent loss of exocrine and
endocrine function.
Clinical pattern of either recurrent exacerbation or
persistent pain.
3. Histopathologic changes:
i)Fibrosis
ii)Reduced number of acinar cells
iii)Reduced number of islet cells of langerhans
iv)Development of strictures
v)Dilatation of pancreatic duct
vi)Pancreatic ductal Calculi
4.
5. Classified into:
Chronic pancreatitis with focal or segmental or diffuse
fibrosis
Chronic pancreatitis with or without stones
Obstructive chronic pancreatitis
Chronic Calcifying Pancreatitis
Chronic inflammatory Pancreatitis
6. Cambridge conference classification of Chronic Pancreatitis: ERCP
Terminology Main duct Abnormal Side
Ducts
Additional
features
Normal Normal None
Equivocal Normal <3
Mild changes Normal >=3
Moderate
changes
Abnormal >3
Marked changes Abnormal >3 1 or more of
Large cavity
obstruction
Filling defects
Severe dilatation
9. Toxic/Metabolic
• Tobacco use potentiate the progression of Chronic
pancreatitis
• Hyperparathyroidism and Hypercalcemia
• MEN 2A
• CRF
• Medications Statins, Steroids, OCP, IF
11. Genetic
• Hereditary Chronic Pancreatitis – Autosomal Dominant-
chromosome 7 q.
• Transition mutation in the cationic trypsinogen gene
PRSS1.
• Mutation in Serine Protease inhibitor- SPINK1
• Mutation in the Cystic Fibrosis Transmembrane
Conductance Regulator gene CFTR.
• Mutation in Anionic Trypsinogen PRSS2.
• Mutation in Chymotrypsin C.
12. Autoimmune
• Lymphoplasmacytic sclerosing Pancreatitis
• Gland enlargement, diffuse duct narrowing, stenosis of
intra pancreatic portion of bile duct.
• HPE Pancreas Parenchyma infiltrated by both CD4+
and CD8+ lymphocytes and IgG4 plasma cells with
Interstitial Fibrosis and Acinar cell atrophy.
• ABx against Peptide homologous to PBP in H.Pylori and
Ubiquitin-protein ligase E3 component n-recognin 2.
• Primary treatment is Steroids.
13. Recurrent acute
• Of any etiology
• Accumulated effects of post inflammatory scarring and
necrosis.
• Priming of pancreatic stellate cells to induce fibrosis.
• Radiation and scarring.
14. Obstruction
• Congenital / Functional / Acquired
• Pancreatic / Ampullary tumors
• Post injury pancreatic duct fibrosis
• Anatomical variation in the pancreatic ductal system
30. Resection of Head of Pancreas with CBD, Distal Stomach,
Duodenum and Proximal Jejunum.
Two layered end to side Pancreatico jejunostomy and a
gastrojejunostomy
Pain releif 85%
Diabetes 50% subsequent 10 years.
Exocrine insufficiency 50%
Mortality <5%
33. Division of pancreatic neck
Removal of head of pancreas
Leaving small rim of pancreatic tissue
End to end and side to side Roux en Y pancreatico
jejunostomy
38. Lateral Pancreatico Jejunostomy
Retrocolic side to side Roux en Y Pancreatico
Jejunostomy
Without Splenectomy and distal Pancreatic
ojejunostomy.
39.
40.
41.
42. Duodenum sparing resectio of pancreatic head
Without division of pancreatic neck
Longitudinal pancreaticojejunostomy
75% releif of pain
43. IZBICKI PROCEDURE
Excavation of pancreatic head
V shaped longitudinal wedge resection
Larearal decompressive pancreatico jejunostomy.
92% Pain releif
44.
45. Small duct disease with diffuse parenchymal
inflammation.
Heriditary syndromes
Prior pancreatic operations.
Pain releif 75%.
