Lecture notes
chronic pancreatitis
- Module
- General Surgery 2
- Institution
- Cambridge University (CAM)
Lecture notes of 22 pages for the course General Surgery 2 at CAM (.)
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Chronic PancreatitisChronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas,
characterized by irreversible morphologic changes and gradual fibrotic replacement of
the gland.
•Loss of exocrine and endocrine function results from parenchymal fibrosis.
Nomenclature and definition
•Chronic pancreatitis is a continuing inflammatory disease of the pancreas that typically
presents with upper abdominal and back pain.
•In 10 to 15% of patients, pain may be absent.
•Only 15 to 20% have exocrine insufficiency and a similar proportion are diabetic.
•The only sign of an inflammatory process may be fibrosis, indicative of earlier
inflammation.
Epidemiology
•In temperate areas alcohol misuse accounts formost cases
•It mainly affects men aged 40-50 years
•8.2/100000 and a prevalence of 27.4/100000 were found in the prospective
Copenhagen Pancreatitis Study
Pathogenesis
•Alcohol induced chronic pancreatitis -150/200 mg alcohol/day -3 to 7years
•Increasingfibrosis of the acinartissue and the relative sparing of the islets until a late
stage.
•The viscosity of pancreatic secretion increases, with protein precipitates developing; in
addition, the fibrotic process tends to form strictures of the main and major ducts.
•Stone formation -nucleus of protein in which nickel and iron can be found; around this,
layers of calcium carbonate develop
•The chronic pancreatitis that develops in children and young adults in India and other
areas nearer the equator has been labeled tropical chronic pancreatitis
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, •Genetics –PSTI (SPINK1) gene inhibition and Cystic fibrosis transmembrane conductance
regulator (CFTR) mutations in idiopathic cases
•The role of antioxidants in the protective mechanisms is probably very important and
cigarette smoking has an additional adverse effect
•20 cigarettes per day, irrespective of alcohol intake, have a threefold increase in the
risk for developing pancreatic cancerin those who abuse alcohol.
TIGAR-O classification
•Toxic-metabolic (alcohol)
•Idiopathic
•Genetic
•Autoimmune
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