For specialist surgeon

1. CHRONIC PANCREATITIS
LT COL SM SHAHADAT HOSSAIN
MCPS,FCPS(Surgery)FCPS(Thoracic surgery)
Adv Trg on Thoracoscopy CNUH, SouthK orea

2. CHRONIC PANCREATITIS
 Progressive inflammatory disease in which there is
irreversible destruction of pancreatic tissue.
 Characterised by severe pain and with loss of exocrine
and endocrine function.
 Male: female:4:1.
 Mean age 40 years.

3. TYPES
A. Chronic relapsing pancreatitis
B. Chronic pancreatitis (persistent), which may be
i. Chronic non-calcifying
ii. Calcifying pancreatitis

4. AETIOLOGY
1. High alcohol consumption(60–70%)
2. Pancreatic duct stricture
3. Pancreas divisum, annular pancreas, cystic fibrosis
4. Hereditary pancreatitis-pancreatic ca
5. Malnutrition
6. Hyperlipidaemia and hypercalcaemia
7. Tropical pancreatitis-DM
8. Autoimmune pancreatitis
9. Idiopathic(30%),

5. CLINICAL FEATURES
Pain in epigastric region (80%)
 It is persistent and severe, which radiates to back.
 Pain is due to irritation of retropancreatic nerves,
or
 due to ductal dilatation and stasis
or
 due to chronic inflammation itself.

6. CLINICAL FEATURES
Exocrine dysfunction:
 Diarrhoea
 Loss of weight and appetite
 Steatorrhoea (90%)
 Malabsorption.

7. CLINICAL FEATURES
Endocrine dysfunction: Diabetes mellitus.
Mild jaundice is due to narrowing of retropancreatic bile
duct and cholangitis.

8. Triad of chronic pancreatitis
1. Pancreatic calcification
2. Steatorrhoea
3. Diabetes mellitus

9. INVESTIGATIONS
a. Serum amylase
b. Abdominal x-ray: pancreatic calcifications
c. CT or MRI scan: outline of the gland
d. MRCP/ERCP: biliary obstruction and the state of
pancreatic duct
e. EUS

10. Plain x-ray abdomen

11. CT scan abdomen
To see
• pseudocyst
• Calcification, ductal stones,
• duct stricture and dilatation
• CBD status.

12. ERCP

13. EUS FINDINGS
1. Presence of stones
2. Cysts
3. Lobularity
4. Dilatation or irregularity of main pancreatic duct
5. Hyperechoic foci and strands
Presence of four or more are highly suggestive of chronic
pancreatitis

14. TREATMENT
A. Conservative
1. Avoid alcohol.
2. Stop smoking.
3. Low fat, high protein, high carbohydrate diet; small and
more frequent meals.
4. Pancreatic enzyme supplements, vitamins and minerals,
medium chain fatty acids.
5. For pain—analgesics, splanchnic nerve or coeliac plexus
block.

15. TREATMENT
6. Control of diabetes by oral hypoglycaemics or insulin.
7. Somatostatin and its analogues.
8. For Steatorrhoea-Esomeprazole.

16. SURGERY
1. Partington-Rochelle operation

17. Surgery
2.Pancreatojejunostomy- more than 8 mm, dilated duct

18. Surgery
3..Pancreatoduodenectomy- mass in the head

19. Surgery
• Total pancreatectomy