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    Chronic Pancreatitis 2

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    Umulkheir ahmed
    Chronic pancreatitis is defined as permanent and irreversible damage to the pancreas resulting in chronic inflammation, fibrosis, and destruction of pancreatic tissue over time. Diagnosis involves tests of pancreatic function like fecal fat tests and tests of pancreatic structure like imaging exams. Treatment focuses on conservative management of pain, cessation of alcohol and smoking, pancreatic enzyme supplements, and endoscopic or surgical interventions for severe cases. Pancreatic cancer arises mainly from pancreatic exocrine cells and causes vague abdominal symptoms until late stages. Diagnosis involves physical exam findings and tumor staging, while treatment options include surgery for resectable cases or palliative options for advanced disease.

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    Chronic Pancreatitis 2

    Uploaded by

    Umulkheir ahmed
    8 views37 pages
    Chronic pancreatitis is defined as permanent and irreversible damage to the pancreas resulting in chronic inflammation, fibrosis, and destruction of pancreatic tissue over time. Diagnosis involves tests of pancreatic function like fecal fat tests and tests of pancreatic structure like imaging exams. Treatment focuses on conservative management of pain, cessation of alcohol and smoking, pancreatic enzyme supplements, and endoscopic or surgical interventions for severe cases. Pancreatic cancer arises mainly from pancreatic exocrine cells and causes vague abdominal symptoms until late stages. Diagnosis involves physical exam findings and tumor staging, while treatment options include surgery for resectable cases or palliative options for advanced disease.

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    Chronic pancreatitis is defined as permanent and irreversible damage to the pancreas resulting in chronic inflammation, fibrosis, and destruction of pancreatic tissue over time. Diagnosis involves tests of pancreatic function like fecal fat tests and tests of pancreatic structure like imaging exams. Treatment focuses on conservative management of pain, cessation of alcohol and smoking, pancreatic enzyme supplements, and endoscopic or surgical interventions for severe cases. Pancreatic cancer arises mainly from pancreatic exocrine cells and causes vague abdominal symptoms until late stages. Diagnosis involves physical exam findings and tumor staging, while treatment options include surgery for resectable cases or palliative options for advanced disease.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    8 views37 pages

    Chronic Pancreatitis 2

    Uploaded by

    Umulkheir ahmed
    Chronic pancreatitis is defined as permanent and irreversible damage to the pancreas resulting in chronic inflammation, fibrosis, and destruction of pancreatic tissue over time. Diagnosis involves tests of pancreatic function like fecal fat tests and tests of pancreatic structure like imaging exams. Treatment focuses on conservative management of pain, cessation of alcohol and smoking, pancreatic enzyme supplements, and endoscopic or surgical interventions for severe cases. Pancreatic cancer arises mainly from pancreatic exocrine cells and causes vague abdominal symptoms until late stages. Diagnosis involves physical exam findings and tumor staging, while treatment options include surgery for resectable cases or palliative options for advanced disease.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 37

    Chronic pancreatitis

    Abdifatah Osman,MBBS,Mmed(General Surgery)


    The traditional definition of chronic
    pancreatitis has been permanent and
    irreversible damage to the pancreas,
    with histologic evidence of chronic
    inflammation, fibrosis, and destruction
    of exocrine (acinar cell) and endocrine
    (islets of Langerhans) tissue.
    • Diabetes mellitus or a history suggestive of
    malabsorption (i.e., steatorrhea) indicates that
    significant pancreatic endocrine or exocrine
    function has been lost.

    • and this is most compatible with the diagnosis


    of chronic pancreatitis.
    Diagnosis
    • Tests Of Function • Tests of Structure
    Pancreatic Function Tests
    • Steatorrhea – – A 72 hour fecal fat determination
    – excretion of >7g fat per day
    – Fecal Elastase more sensitive and specific
    Imaging
    • Plain x-ray
    • CT, MRI & USG
    – Calcifications
    – Ductal Dilatation
    – Size of the pancreas
    – Fluid collections
    – MRCP is becoming the diagnostic test of
    choice
    Treatment
    • Conservative management
    • Pain Management
    • Cessation of alcohol
    • Small meals, low in fat
    • Hydration
    • Cessation of smoking
    • Pancreatic enzyme supplements

    • Endoscopic treatment
    Surgery
    • Patients who fail medical therapy
    • Decompression or resection.
    Pancreatic carcinoma
    Pathology
    • Ductal adenocarcinoma accounts for about
    85% of all neoplasms.
    • And more than 95% of all pancreatic cancers
    arise from the exocrine (digestive enzymes)
    elements.
    • Cancers that arise from the endocrine cells
    (neuroendocrine, islet cells) account for 5% or
    less
    Clinical features
    • Tumor in the head
    -Symptoms include unexplained episodes of
    pancreatitis, painless jaundice, nausea,
    vomiting, steatorrhea, and unexplained weight
    loss.
    • Patients with tumors arising in the neck, body,
    or tail of the pancreas usually do not develop
    jaundice or gastric outlet obstruction.

    • Their symptoms may be limited to


    unexplained weight loss and vague upper
    abdominal pain until the tumor has grown
    extensively and spread beyond the pancreas.
    Physical findings
    • Liver nodules indicative of metastases can
    sometimes be felt.
    • Metastatic subumbilical (“Sister Mary Joseph
    node”) and pelvic peritoneal (“Blumer's
    shelf”) deposits,
    • As well as left supraclavicular
    lymphadenopathy (“Virchow's node”),
    indicate the presence of distant metastases.
    • A palpable gallbladder in a patient with
    painless jaundice (i.e., Courvoisier's sign)
    suggests the presence of a periampullary
    neoplasm.
    Stages
    • 1-4 stages
    Survival
    • Survival Surgery offers the only cure but only
    10-20% are candidates for resection and even
    in this group the 5 year survival is only 20%
    and the median 13 to 20 months
    • Locally advanced the survival is 8 to 14
    months
    • Up to 60% already have metastases and a
    median survival of only 4 to 6 months
    Treatment
    • Surgical treatment

    • Palliative treatment
    • Pancreaticoduodenectomy (whipple
    procedure) (pylorus-preserving Whipple or
    standard Whipple) for carcinoma of the head
    of pancreas.

    • Distal pancreatectomy for carcinoma of the


    tail and body of pancreas.
    Distal pancreatectomy
    Unresectable
    • Obstructive jaundice?
    • Thank you .

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