Chronic Pancreatitis Lecture Notes

Introduction

• Chronic Pancreatitis differs from acute pancreatitis.
  • Acute Pancreatitis: Inflammation leads to excessive enzyme release.
  • Chronic Pancreatitis: Chronic inflammation causes the pancreas to become stiff and fibrotic, losing its function over time.

Causes

• Chronic alcohol use
• Gallstones

Comparison: Acute vs Chronic Pancreatitis

• Lifelong Pancreatic Enzyme Replacement

  • Acute: No, too many enzymes already.
  • Chronic: Yes, pancreas loses the ability to secrete enzymes.

• Monitor for Development of Diabetes

  • Acute: Possible hyperglycemia, but temporary concern.
  • Chronic: Long-term concern due to pancreas losing insulin secretion function.

• Need to be NPO and have an NG Tube

  • More relevant for acute pancreatitis.

• Daily Proton Pump Inhibitor

  • Applies to both due to gastrointestinal irritation concerns.

• Risk of Shock

  • Acute pancreatitis poses a higher risk due to fluid shifts and inflammation.

• Monitor for Respiratory Infections/Failure

  • More concerned in acute due to risk of ARDS and acute respiratory failure.

• Alternative Nutrition (TPN, PPN)

  • More relevant for acute due to bowel rest requirements.

• Elevated AST and ALT

  • Possible in both, often more elevated in acute.

Symptoms of Chronic Pancreatitis

• Abdominal Pain
  • Gnawing or heavy pain, not relieved by food or antacids.
• Weight Loss
  • Due to malabsorption from lack of digestive enzymes.
• Fatty Stools
  • Lack of fat digestion due to enzyme deficiency.
• Jaundice
  • Possible bilirubin buildup causing jaundice or dark urine.
• Insulin Deficiency
  • Decreased insulin production leading to hyperglycemia.

Assessment

• GI symptoms, nutritional status.
• Skin, urine, and stool changes.
• Monitor for signs of diabetes and abdominal complications.

Complications

• Fluid and electrolyte imbalances.
• Ascites and pleural effusion.

Lab Work and Diagnostics

• Amylase and lipase levels.
• Liver function tests and bilirubin levels.
• Fat content in stool samples.
• Hemoglobin A1C for diabetes risk.
• Imaging like ultrasound or CT.

Management and Treatment

• Prevent/manage complications (e.g., use of PPIs).
• Monitor blood glucose levels.
• Dietary management: low-fat, small, bland meals.
• Pancreatic enzyme replacement with pancrealipase.
• Pain management support.

Lifestyle Adjustments

• Avoid smoking, alcohol, and caffeine.
• Educate on early signs of acute attacks.
• Focus on lifestyle changes to prevent further attacks.

Conclusion

• Awareness of lifestyle modifications and symptom management is key.
• Next lecture will cover biliary disorders related to gallbladder issues.