L34 chronic pancreatitis st

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L34 chronic pancreatitis st

  1. 1. ChronicPancreatitisLecture 34
  2. 2. • The chief distinction between acute andchronic pancreatitis is theirreversible impairment in pancreaticfunction that is characteristic of chronicpancreatitis.
  3. 3. Causes90% 0r 2/3
  4. 4. Causes of chronic pancreatitisGallstones,HyperparathyroidismCongenitalmalformation
  5. 5. PancreasDivisum
  6. 6. Annular Pancreas
  7. 7. Pathogenesis
  8. 8. Pathogenesis
  9. 9. Pathogenesis1 23Not wellunderstoodAlmost allindividualswithrepeatedepisodes ofacutepancreatitislater developchronicpancreatitis.
  10. 10. Events in Pathogenesis
  11. 11. PathogenesisMediators In Chronic Pancreatitismonocyte chemoattractant protein.
  12. 12. Profibrogenic CytokinesStellate cells
  13. 13. MorphologyAtrophyFibrosisDilationChr. Infiltrate
  14. 14. Morphology
  15. 15. Morphology
  16. 16. Lymphoplasmacytic SclerosingPancreatitis (Autoimmune Pancreatitis)
  17. 17. Chronic pancreatitis. A, Extensive fibrosis and atrophy has left only residualislets (left) and ducts (right), with a sprinkling of chronic inflammatory cells andacinar tissue. B, A higher power view demonstrating dilated ducts with inspissatedeosinophilic ductal concretions in a person with alcoholic chronic pancreatitis.
  18. 18. Clinical featuresabdominal pain:– may be continuous, intermittent or absent– Pattern is often atypical• RUQ or LUQ of the back• Diffuse throughout upper abdomen• May be referred to the anterior chest or flank– Typical form:• Persistent , deep-seated,• Unresponsive to antacids• Worsened by alcohol intake or a heavy meal (especially fattyfoods)• Often need narcotics
  19. 19. • Pancreatic insufficiency– Weight loss– Fat malabsorption:• Steatorrhea: 15% of patients present with steatorrheaand no pain– Pancreatic diabetes:• Like DM1 needs insulin , but risk of hypoglycemia ismore than it (because alfa cells is also affected– Fat-soluble vitamin deficiency rare
  20. 20. Diagnosis
  21. 21. Complications• pseudocyst formation• bile duct or duodenal obstruction• pancreatic ascites or pleural effusion• splenic vein thrombosis• Pseudoaneurysms• pancreatic cancer• acute attacks of pancreatitis( particularly alcoholicswho continue drinking)
  22. 22. Treatment

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