1. Chronic
Pancreatitis
Lecture 34

3. • The chief distinction between acute and
chronic pancreatitis is the
irreversibl
e impairment in pancreatic
function that is characteristic of chronic
pancreatitis.

4. Causes
90% 0r 2/3

5. Causes of chronic pancreatitis
Gallstones,
Hyperparathyroidism
Congenital
malformation

6. Pancreas
Divisum

7. Annular Pancreas

9. Pathogenesis

10. Pathogenesis

11. Pathogenesis
1 2
3
Not well
understood
Almost all
individuals
with
repeated
episodes of
acute
pancreatitis
later develop
chronic
pancreatitis.

12. Events in Pathogenesis

13. Pathogenesis
Mediators In Chronic Pancreatitis
monocyte chemoattractant protein.

14. Profibrogenic Cytokines
Stellate cells

18. Morphology
Atrophy
Fibrosis
Dilation
Chr. Infiltrate

19. Morphology

20. Morphology

21. Lymphoplasmacytic Sclerosing
Pancreatitis (Autoimmune Pancreatitis)

22. Chronic pancreatitis. A, Extensive fibrosis and atrophy has left only residual
islets (left) and ducts (right), with a sprinkling of chronic inflammatory cells and
acinar tissue. B, A higher power view demonstrating dilated ducts with inspissated
eosinophilic ductal concretions in a person with alcoholic chronic pancreatitis.

23. Clinical features
abdominal 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 fatty
foods)
• Often need narcotics

24. • Pancreatic insufficiency
– Weight loss
– Fat malabsorption:
• Steatorrhea: 15% of patients present with steatorrhea
and no pain
– Pancreatic diabetes:
• Like DM1 needs insulin , but risk of hypoglycemia is
more than it (because alfa cells is also affected
– Fat-soluble vitamin deficiency rare

25. Diagnosis

27. Complications
• pseudocyst formation
• bile duct or duodenal obstruction
• pancreatic ascites or pleural effusion
• splenic vein thrombosis
• Pseudoaneurysms
• pancreatic cancer
• acute attacks of pancreatitis( particularly alcoholics
who continue drinking)

28. Treatment