CHRONIC PANCREATITIS- EPIGASTRIC PAIN #surgicaleducator #epigastricabdominalpain #chronicpancreatitis #usmle #babysurgeon #surgicaltutor • Dear Viewers, • Greetings from “Surgical Educator” • Today I have uploaded a video on Chronic Pancreatitis- a didactic lecture. I have already uploaded 1 more video on the same topic, in image- based questions for Hepato-biliary- pancreatic pathologies. • It is one of the uncommon surgical problems you see in surgical wards. • I have discussed the various causes for Epigastric pain, etiology, pathology, clinical features, investigations, complications and treatment of Acute Pancreatitis. • I have also included a mind map and a treatment algorithm for Chronic Pancreatitis. • I hope the video will be very useful and you will enjoy it. • You can watch all my surgical teaching videos in the following link: • youtube.com/c/surgicaleducator • Thank you for watching the video.

1. CHRONIC
PANCREATITIS
EPIGASTRIC PAIN
AN OVRVIEWDr.B.Selvaraj MS;Mch;FICS;
“Surgical Educator”
Malaysia

2. CHRONIC PANCREATITIS
 Different causes for epigastric pain
 Epidemiology
 Etiology
 Pathology
 Clinical features
 Investigations
 Treatment
 Complications
 Ac Pancreatitis Vs Ch Pancreatitis
 Mindmap
 Treatment Algorithm

3. CHRONIC PANCREATITIS
D/D for Epigastric Pain

4. CHRONIC PANCREATITIS
-Epidemiology
 Chronic pancreatitis is “continuing
inflammatory disease of the pancreas
characterized by irreversible morphologic
change and causing pain and/or permanent
loss of function” [of the pancreas]. .
 Habitual alcohol use is responsible for 70% of
chronic pancreatitis cases, however, the precise
pathophysiology of this disease is complex and
multifactorial.
 Up to 90% of patients with chronic pancreatitis
will experience pain at some point in their
disease process.
 Pancreatic anatomic changes in chronic
pancreatitis are widely heterogeneous;
selecting the proper operation for individual
patients is crucial to obtain excellent outcomes.
 Incidence of chronic pancreatitis 2 to 10 new
cases per 100 000 population per year with a
prevalence of around 13 cases per 100 000
 In certain parts of the world, such as southern
India, the prevalence is much higher (100–200
per 100 000).
 In the United States, the incidence and
prevalence of CP are 4/100,000 and13/100,000,
respectively
 The disease occurs more frequently in men
(male:female ratio of 4:1), and the mea age of
onset is about 40 years.

5. CHRONIC PANCREATITIS
-ETIOLOGY
Multifactorial aetiology of chronic pancreatitis can be remembered by the nemonic- “ M-ANNHEIM”

6. CHRONIC PANCREATITIS
-ETIOLOGY
CLASSIFICATION OF CHRONIC PANCREATITIS BY THE TIGAR-O SYSTEM

7. CHRONIC PANCREATITIS
-PATHOLOGY
 Pancreatic stellate cells reported to play a role in
initiating fibrosis, particularly in alcoholic pancreatitis.
 They are activated by inflammatory cytokines,
transforming them into myofibroblast- like cells that
instigate fibrosis.
 It is characterized by progressive inflammation and
fibrosis of pancreas leading to irreversible structural
changes causing both endocrine and exocrine
dysfunction.
 Pain is mediated by two channels:
-High-pressure pancreatic duct obstruction can result
in constant pain.
-Chemical protease release from damaged tissue can
activate nociceptive neurones and result in pain.

8. CHRONIC PANCREATITIS
-ETIOPATHOGENESIS

9. CHRONIC PANCREATITIS
-Clinical Features
 Pain:
a) Severe, persistent, recurrent
b) Mid-epigastric
c) Radiates to back
d) Aggravated by food/ alcohol
 Nausea & vomiting, anorexia
 Constipation, flatulence
 Steatorrhea
 Weight loss
 Epigastric tenderness
 Epigastric guarding
 Frank diabetes in 20% of patients
 Triad:
- Calcifications
- Steatorrhea
- Type 2 diabetes mellitus

10. -
INVESTIGATIONS
 Serum
a) Amylase: Normal/ mildly ↑sed
b) WBC: Normal/ mildly ↑sed
c) Glucose: ↑sed
d) Liver enzymes: ↑sed

11. -
INVESTIGATIONS
Plain AXR showing gross calcification in
pancreatic area

12. -
INVESTIGATIONS
USG showing Ductular dilatation, cysts, and
calcifications

13. -
INVESTIGATIONS
CECT showing atrophy of the pancreas, duct
dilatation and calcifications

14. -
INVESTIGATIONS
MRCP showing ductal stricture with
upstream dilatation
ERCP With “ Chain of lakes”
appearance

15. CHRONIC PANCREATITIS
-TREATMENT

16. CHRONIC PANCREATITIS
-TREATMENT
ENDOSCOPIC TREATMENT

17. CHRONIC PANCREATITIS
-TREATMENT
SURGIAL TREATMENT

18. CHRONIC PANCREATITIS
-TREATMENT
SURGIAL TREATMENT

19. CHRONIC PANCREATITIS
-TREATMENT
SURGIAL TREATMENT

20. CHRONIC PANCREATITIS
-TREATMENT
SURGIAL TREATMENT

21. CHRONIC PANCREATITIS
-TREATMENT
SURGIAL TREATMENT
Pylorus preserving Pancreato-
duodenectomy
Pancreato
Duodenec
tomy

22. -
COMPLICATIONS
 Deficiency of exo & endo-crine functions
resulting in Steatorrhea and Type 2 diabetes
respectively
 Persistent pain + acute exacerbations
 Malnutrition & general debility
 Analgesic dependency
 Pseudocyst of pancreas
 Splenic vein thrombosis
 GOO due to Pseudocyst
 Duodenal obstruction
 Pancreatic carcinoma

23. Vs ACUTE
PANCREATITIS

24. CHRONIC PANCREATITIS
MINDMAP

25. CHRONIC PANCREATITIS
TREATMENT ALGORITHM

26. Peripheral Arterial Diseases(PAD)