CHRONIC PANCREATITIS- EPIGASTRIC PAIN
#surgicaleducator #epigastricabdominalpain #chronicpancreatitis #usmle #babysurgeon #surgicaltutor
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Chronic Pancreatitis- a didactic lecture. I have already uploaded 1 more video on the same topic, in image- based questions for Hepato-biliary- pancreatic pathologies.
• It is one of the uncommon surgical problems you see in surgical wards.
• I have discussed the various causes for Epigastric pain, etiology, pathology, clinical features, investigations, complications and treatment of Acute Pancreatitis.
• I have also included a mind map and a treatment algorithm for Chronic Pancreatitis.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
4. CHRONIC PANCREATITIS
-Epidemiology
Chronic pancreatitis is “continuing
inflammatory disease of the pancreas
characterized by irreversible morphologic
change and causing pain and/or permanent
loss of function” [of the pancreas]. .
Habitual alcohol use is responsible for 70% of
chronic pancreatitis cases, however, the precise
pathophysiology of this disease is complex and
multifactorial.
Up to 90% of patients with chronic pancreatitis
will experience pain at some point in their
disease process.
Pancreatic anatomic changes in chronic
pancreatitis are widely heterogeneous;
selecting the proper operation for individual
patients is crucial to obtain excellent outcomes.
Incidence of chronic pancreatitis 2 to 10 new
cases per 100 000 population per year with a
prevalence of around 13 cases per 100 000
In certain parts of the world, such as southern
India, the prevalence is much higher (100–200
per 100 000).
In the United States, the incidence and
prevalence of CP are 4/100,000 and13/100,000,
respectively
The disease occurs more frequently in men
(male:female ratio of 4:1), and the mea age of
onset is about 40 years.
7. CHRONIC PANCREATITIS
-PATHOLOGY
Pancreatic stellate cells reported to play a role in
initiating fibrosis, particularly in alcoholic pancreatitis.
They are activated by inflammatory cytokines,
transforming them into myofibroblast- like cells that
instigate fibrosis.
It is characterized by progressive inflammation and
fibrosis of pancreas leading to irreversible structural
changes causing both endocrine and exocrine
dysfunction.
Pain is mediated by two channels:
-High-pressure pancreatic duct obstruction can result
in constant pain.
-Chemical protease release from damaged tissue can
activate nociceptive neurones and result in pain.
9. CHRONIC PANCREATITIS
-Clinical Features
Pain:
a) Severe, persistent, recurrent
b) Mid-epigastric
c) Radiates to back
d) Aggravated by food/ alcohol
Nausea & vomiting, anorexia
Constipation, flatulence
Steatorrhea
Weight loss
Epigastric tenderness
Epigastric guarding
Frank diabetes in 20% of patients
Triad:
- Calcifications
- Steatorrhea
- Type 2 diabetes mellitus