Chronic Pancreatitis

<p>45–80%</p> Signup and view all the answers

<p>19%</p> Signup and view all the answers

<p>Brittle diabetes</p> Signup and view all the answers

<p>Using tailored doses of pancreatic enzyme replacement therapy</p> Signup and view all the answers

<p>Antioxidant therapy</p> Signup and view all the answers

<p>Zenpep</p> Signup and view all the answers

<p>Liver fibrosis</p> Signup and view all the answers

<p>Prednisone</p> Signup and view all the answers

<p>Endoscopic therapy or surgery</p> Signup and view all the answers

<p>Tobacco and alcohol use</p> Signup and view all the answers

<p>Opioid addiction</p> Signup and view all the answers

<p>Low-fat diet</p> Signup and view all the answers

<p>Endoscopic placement of stents</p> Signup and view all the answers

<p>50%</p> Signup and view all the answers

<p>Modified Puestow procedure</p> Signup and view all the answers

<p>Risk of diabetes mellitus</p> Signup and view all the answers

<p>Perioperative administration of somatostatin</p> Signup and view all the answers

<p>For pseudocysts over 6 cm in diameter</p> Signup and view all the answers

<p>Endoscopic stent placement</p> Signup and view all the answers

<p>Pancreatic sphincterotomy</p> Signup and view all the answers

<p>50%</p> Signup and view all the answers

<p>Radiation therapy to the pancreas</p> Signup and view all the answers

<p>Pancreatic cancer</p> Signup and view all the answers

<p>Constant pain</p> Signup and view all the answers

<p>All patients should be referred</p> Signup and view all the answers

<p>10-30%</p> Signup and view all the answers

<p>BRCA1</p> Signup and view all the answers

<p>TIGAR-O</p> Signup and view all the answers

<p>SAPE hypothesis</p> Signup and view all the answers

<p>80%</p> Signup and view all the answers

<p>Tachycardia</p> Signup and view all the answers

<p>Impaired inhibitory pain modulation by the CNS</p> Signup and view all the answers

<p>Steatorrhea</p> Signup and view all the answers

<p>20-30%</p> Signup and view all the answers

<p>Type 3</p> Signup and view all the answers

<p>Chronic or recurrent episodes of acute pancreatitis</p> Signup and view all the answers

<p>Surgical intervention tailored to the cause of pain</p> Signup and view all the answers

<p>Response to secretin stimulation test</p> Signup and view all the answers

<p>Vitamin B12 malabsorption</p> Signup and view all the answers

<p>CT or MRI</p> Signup and view all the answers

<p>ERCP</p> Signup and view all the answers

<p>Histology</p> Signup and view all the answers

<p>Imaging features</p> Signup and view all the answers

<p>Opioid addiction, brittle diabetes, pseudocyst or abscess</p> Signup and view all the answers

<p>Diffuse enlargement and hypoattenuation</p> Signup and view all the answers

<p>ERCP</p> Signup and view all the answers

<p>Response to pancreatic enzyme supplements</p> Signup and view all the answers

<p>Histology</p> Signup and view all the answers

<p>Imaging features</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>True</p> Signup and view all the answers

<p>False</p> Signup and view all the answers

<p>Alcoholism = Most common cause in Western societies Tobacco smoking = Risk factor for idiopathic chronic pancreatitis Hyperparathyroidism = About 2% of patients develop pancreatitis Obesity = Can lead to pancreatic steatosis and increased risk of cancer</p> Signup and view all the answers

<p>Calcifications = Recommended for diagnosis Ductal dilatation = Characteristic feature Gland atrophy = Characteristic feature Pancreatic steatosis = Can lead to exocrine and endocrine insufficiency</p> Signup and view all the answers

<p>M-ANNHEIM = Includes 'pancreatitis with multiple risk factors' TIGAR-O = Includes 'Recurrent and severe acute pancreatitis' SAPE (Sentinel Acute Pancreatitis Event) = Explains the pathogenesis of chronic pancreatitis Autoimmune factors = Can be a cause of chronic pancreatitis</p> Signup and view all the answers

<p>Percutaneous celiac plexus nerve block = Considered ineffective for chronic pain Endoscopic therapy = Successful in 80% of cases Radiation therapy = Not a well-established method for relieving refractory pain Surgical intervention = Tailored to the cause of pain and may resolve chronic pain</p> Signup and view all the answers

<p>Tobacco and alcohol use = Develops in 5% of patients after 20 years Hereditary pancreatitis = 19% risk of pancreatic cancer by age 70 Chronic pancreatitis with opioid addiction = Increased risk related to tobacco and alcohol use Exocrine pancreatic insufficiency = No direct risk factor mentioned in the text</p> Signup and view all the answers

<p>Low-fat diet = Medical measures for chronic pancreatitis Pancreatic enzyme replacement therapy = Treatment for exocrine pancreatic insufficiency Antioxidant therapy = Inhibiting stress on the pancreas by toxic metabolites Prednisone = Treatment for autoimmune pancreatitis</p> Signup and view all the answers

<p>Viokace = FDA-approved pancreatic enzyme preparations Creon = FDA-approved pancreatic enzyme preparations Ultresa = FDA-approved pancreatic enzyme preparations Zenpep = FDA-approved pancreatic enzyme preparations</p> Signup and view all the answers

<p>Endoscopic therapy = May be indicated to treat complications and relieve obstruction Surgery = May be indicated to treat complications and relieve obstruction Biliary drainage = May regress liver fibrosis in chronic pancreatitis patients Endoscopic placement of stents = May relieve distal bile duct obstruction</p> Signup and view all the answers

<p>Serum amylase and lipase levels = May be elevated during acute attacks, but normal values do not exclude the diagnosis Imaging with CT or MRI = Recommended for diagnosis, showing calcifications, ductal dilatation, and gland atrophy Endoscopic ultrasonographic criteria = Include hyperechoic foci with shadowing for chronic pancreatitis diagnosis ERCP = Most sensitive imaging study and may show dilated ducts, stones, strictures, or pseudocysts</p> Signup and view all the answers

<p>Vitamin B12 malabsorption = Detectable in about 40% of patients, but clinical deficiency is rare Autoimmune pancreatitis = Has characteristic imaging features including diffuse enlargement, hypoattenuation, and irregular narrowing of the main pancreatic duct Exocrine pancreatic insufficiency = Confirmed by response to pancreatic enzyme supplements or secretin stimulation test Opioid addiction = A complication of chronic pancreatitis</p> Signup and view all the answers

<p>Histology = Gold standard for diagnosis when imaging studies are inconclusive Genetic testing for major trypsinogen gene pathogenic variants = Recommended in younger patients with unclear etiology Diagnosis of autoimmune pancreatitis in the United States = Based on the HISORt criteria Complications of chronic pancreatitis = Include pseudocyst or abscess, liver and bile duct issues, and malnutrition</p> Signup and view all the answers

<p>Endoscopic therapy = Successful in 50% of cases Surgery = Successful in 50% for obstruction of the duodenal end of the pancreatic duct Modified Puestow procedure = Provides pain relief in 80% of cases Subtotal or total pancreatectomy = Considered as a last resort, with variable efficacy and risk of pancreatic insufficiency and diabetes mellitus</p> Signup and view all the answers

<p>Perioperative administration of somatostatin or octreotide = May reduce the risk of postoperative pancreatic fistulas Percutaneous celiac plexus nerve block = May be considered for chronic pain and nondilated ducts, with approximately 50% of patients experiencing short-lived relief Radiation therapy to the pancreas = Reported to relieve refractory pain in a single session Pancreatic sphincterotomy, stone fragmentation, and endoscopic stone removal = May relieve pain in selected patients</p> Signup and view all the answers

<p>Endoscopic or surgical drainage = Indicated for symptomatic pseudocysts, especially those over 6 cm in diameter Management of pancreatic ascites or pancreaticopleural fistulas = Managed by endoscopic stent placement across the disrupted duct Percutaneous celiac plexus nerve block = May be considered for chronic pain and nondilated ducts, with approximately 50% of patients experiencing short-lived relief Radiation therapy to the pancreas = Reported to relieve refractory pain in a single session</p> Signup and view all the answers

<p>CFTR gene = Associated with chronic pancreatitis in nearly half of early-onset cases PSTI (SPINK1) gene = Associated with chronic pancreatitis in a quarter of late-onset cases CTRC gene = Associated with chronic pancreatitis PRSS1 gene = Associated with chronic pancreatitis</p> Signup and view all the answers

<p>TIGAR-O = Includes Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis, or Obstructive components M-ANNHEIM = Includes pancreatitis with multiple risk factors SAPE hypothesis = Explains the pathogenesis of chronic pancreatitis Chronic pancreatitis = Self-perpetuating disease characterized by chronic or recurrent episodes of acute pancreatitis and ultimately by pancreatic insufficiency</p> Signup and view all the answers

<p>Persistent or recurrent epigastric and left upper quadrant pain = Clinical finding of chronic pancreatitis Anorexia, nausea, vomiting, constipation, flatulence, weight loss = Clinical finding of chronic pancreatitis Tenderness over the pancreas, mild muscle guarding, ileus = Clinical finding of chronic pancreatitis Steatorrhea = Clinical finding of chronic pancreatitis</p> Signup and view all the answers

<p>Over 80% of adults develop diabetes mellitus within 25 years after the clinical onset of chronic pancreatitis = Reported outcome of chronic pancreatitis Pain results from impaired inhibitory pain modulation by the CNS and may vary over time = Statement regarding pain in chronic pancreatitis The SAPE (Sentinel Acute Pancreatitis Event) hypothesis explains the pathogenesis of chronic pancreatitis = Explanation of chronic pancreatitis pathogenesis Surgical intervention tailored to the cause of pain may resolve chronic pain in chronic pancreatitis = Treatment approach for chronic pancreatitis</p> Signup and view all the answers

<p>Alcoholism = 45-80% of all cases Tobacco smoking = Risk factor for idiopathic chronic pancreatitis and accelerates progression of alcohol-associated chronic pancreatitis Hyperparathyroidism = About 2% of patients with hyperparathyroidism develop pancreatitis Obesity = Can lead to pancreatic steatosis and increased risk of pancreatic cancer</p> Signup and view all the answers

<p>United States = Alcoholism (45-80% of all cases) Tropical Africa and Asia = Tropical pancreatitis related in part to malnutrition Western societies = Obesity leading to pancreatic steatosis and increased risk of pancreatic cancer Global = Genetic, autoimmune, and obstructive factors</p> Signup and view all the answers

<p>Abnormal pancreatic imaging = Associated with chronic or intermittent epigastric pain, steatorrhea, and weight loss Hypoechoic foci with shadowing = Endoscopic ultrasonographic criteria for chronic pancreatitis diagnosis Bile duct compression = Results in elevated alkaline phosphatase and bilirubin levels ERCP = Most sensitive imaging study for chronic pancreatitis</p> Signup and view all the answers

<p>Pancreatic cancer = Main cause of death with chronic pancreatitis Disability and reduced life expectancy = Often results from chronic pancreatitis Liver fibrosis regression = After biliary drainage in chronic pancreatitis patients Jaundice = More than 80% of adults with chronic pancreatitis develop within 25 years after clinical onset</p> Signup and view all the answers

<p>Tobacco and alcohol use = Develops in 5% of patients after 20 years Hereditary pancreatitis = 19% risk of pancreatic cancer by age 70 Opioid addiction = Not a direct risk factor for pancreatic cancer Autoimmune pancreatitis = No specific risk percentage mentioned</p> Signup and view all the answers

<p>Low-fat diet = Part of medical measures for chronic pancreatitis Pancreatic enzyme replacement therapy = Treatment for exocrine pancreatic insufficiency Antioxidant therapy = Inhibiting stress on the pancreas by toxic metabolites Prednisone = Treatment for autoimmune pancreatitis</p> Signup and view all the answers

<p>Viokace = FDA-approved pancreatic enzyme preparation Creon = FDA-approved pancreatic enzyme preparation Ultresa = FDA-approved pancreatic enzyme preparation Zenpep = FDA-approved pancreatic enzyme preparation</p> Signup and view all the answers

<p>Endoscopic therapy = May be indicated to treat complications, relieve obstruction, and attempt pain relief Surgery = May be indicated to treat complications, relieve obstruction, and attempt pain relief Biliary drainage = May regress liver fibrosis in chronic pancreatitis patients Endoscopic placement of stents = May relieve distal bile duct obstruction</p> Signup and view all the answers

<p>Liver fibrosis = May regress after biliary drainage in chronic pancreatitis patients Vitamin B12 malabsorption = Is a rare complication of chronic pancreatitis Genetic testing = Not recommended in younger patients with unclear etiology of chronic pancreatitis Pain correlation = May vary over time, with a correlation with disease duration or imaging findings</p> Signup and view all the answers

<p>Hypoechoic foci with shadowing = Endoscopic ultrasonographic criteria for chronic pancreatitis diagnosis Steatorrhea = May occur early in the course of chronic pancreatitis Detectable feature in about 40% of patients = Characteristic imaging feature of chronic pancreatitis Autoimmune pancreatitis = Has characteristic imaging features</p> Signup and view all the answers

<p>Percutaneous celiac plexus nerve block = May provide short-lived relief for chronic pain and nondilated ducts Radiation therapy to the pancreas = Reported to relieve refractory pain in a single session Endoscopic or surgical drainage = Indicated for symptomatic pseudocysts, especially those over 6 cm in diameter Pancreatic sphincterotomy and stone removal = May relieve pain in selected patients</p> Signup and view all the answers

<p>Endoscopic stent placement across disrupted duct = Pancreatic ascites or pancreaticopleural fistulas Modified Puestow procedure with or without resection of the head of the pancreas = Provides pain relief in 80% of cases Subtotal or total pancreatectomy with islet autotransplantation = Last resort with variable efficacy, risk of pancreatic insufficiency, and diabetes mellitus Somatostatin or octreotide administration = May reduce the risk of postoperative pancreatic fistulas</p> Signup and view all the answers

<p>Constant pain and pain-related disability = Associated with poorer quality of life Current smoking and comorbidities = Associated with poorer quality of life Surgery successful in 50% for obstruction of the duodenal end of the pancreatic duct = May provide relief in selected cases Chronic pancreatitis often leads to disability and reduced life expectancy = With pancreatic cancer as the main cause of death</p> Signup and view all the answers

<p>Endoscopic therapy = Successful in 50% of cases Surgery for obstruction of the duodenal end of the pancreatic duct = Successful in 50% of cases Modified Puestow procedure with or without resection of the head of the pancreas = Provides pain relief in 80% of cases Islet autotransplantation after subtotal or total pancreatectomy = Considered as a last resort with variable efficacy and risk of pancreatic insufficiency and diabetes mellitus</p> Signup and view all the answers

<p>CFTR gene variant = Associated with idiopathic chronic pancreatitis PSTI (SPINK1) gene variant = Associated with genetic factors predisposing nearly half of early-onset cases CTRC gene variant = Associated with genetic factors predisposing a quarter of late-onset cases UGT1A7 gene variant = Associated with genetic factors predisposing to chronic pancreatitis</p> Signup and view all the answers

<p>TIGAR-O classification system = Includes Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis, or Obstructive categories M-ANNHEIM classification system = Includes pancreatitis with multiple risk factors categories SAPE (Sentinel Acute Pancreatitis Event) hypothesis = Explains the pathogenesis of chronic pancreatitis, linking it to a first acute pancreatitis event leading to inflammation and fibrosis Chronic pancreatitis = Characterized by chronic or recurrent episodes of acute pancreatitis and ultimately by pancreatic insufficiency</p> Signup and view all the answers

<p>Alcoholism = Common risk factor for the increased development of pancreatic cancer Tobacco smoking = Risk factor for idiopathic chronic pancreatitis Hyperparathyroidism = May be associated with pancreatitis in about 2% of patients SAPE (Sentinel Acute Pancreatitis Event) hypothesis = Explains the pathogenesis of chronic pancreatitis, linking it to a first acute pancreatitis event leading to inflammation and fibrosis</p> Signup and view all the answers

<p>Endoscopic or surgical drainage = Indicated for symptomatic pseudocysts, especially those over 6 cm in diameter Percutaneous celiac plexus nerve block = May provide short-lived relief in about 50% of patients Biliary drainage = May regress liver fibrosis in chronic pancreatitis patients Pancreatic enzyme preparation = May be recommended for exocrine pancreatic insufficiency</p> Signup and view all the answers

<p>CT or MRI = Showing calcifications, ductal dilatation, and gland atrophy Endoscopic ultrasonography = Hyperechoic foci with shadowing ERCP = Dilated ducts, stones, strictures, or pseudocysts Histology = Gold standard for diagnosis when imaging studies are inconclusive</p> Signup and view all the answers

<p>Opioid addiction = Complication of chronic pancreatitis Brittle diabetes = Complication of chronic pancreatitis Pseudocyst or abscess = Complication of chronic pancreatitis Malnutrition = Complication of chronic pancreatitis</p> Signup and view all the answers

<p>Elevated alkaline phosphatase and bilirubin levels = Result from bile duct compression Exocrine pancreatic insufficiency = Confirmed by response to pancreatic enzyme supplements or secretin stimulation test Vitamin B12 malabsorption = Detectable in about 40% of patients Genetic testing for major trypsinogen gene pathogenic variants = Recommended in younger patients with unclear etiology</p> Signup and view all the answers

<p>Autoimmune pancreatitis = Characteristic imaging features include diffuse enlargement, hypoattenuation, and irregular narrowing of the main pancreatic duct Diagnosis of autoimmune pancreatitis in the United States = Based on the HISORt criteria Serum amylase and lipase levels = May be elevated during acute attacks, but normal values do not exclude the diagnosis Endoscopic ultrasonographic criteria = Hyperechoic foci with shadowing</p> Signup and view all the answers