Chronic Pancreatitis

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156 Questions

What is the most common cause of chronic pancreatitis in Western societies?

Obesity

What is the mnemonic for the predisposing factors of chronic pancreatitis mentioned in the text?

TIGAR­O

In which age group does chronic pancreatitis peak in the United States?

46–55 years

What percentage of all chronic pancreatitis cases are attributed to alcoholism?

45–80%

What is the risk of developing pancreatic cancer in patients with hereditary pancreatitis by age 70?

19%

Which of the following is a common complication in chronic pancreatitis patients?

Brittle diabetes

What is the recommended approach for treating exocrine pancreatic insufficiency?

Using tailored doses of pancreatic enzyme replacement therapy

What has shown promise in inhibiting stress on the pancreas by toxic metabolites in some cases?

Antioxidant therapy

Which of the following is an FDA-approved pancreatic enzyme preparation?

Zenpep

What may regress after biliary drainage in chronic pancreatitis patients?

Liver fibrosis

What is an effective induction and maintenance agent for treating autoimmune pancreatitis?

Prednisone

What may be indicated in chronic pancreatitis to treat complications, relieve obstruction, and attempt pain relief?

Endoscopic therapy or surgery

What is a common risk factor for the increased development of pancreatic cancer?

Tobacco and alcohol use

What is the common risk factor for complications in chronic pancreatitis patients?

Opioid addiction

What is the recommended diet for medical management of chronic pancreatitis?

Low-fat diet

What may relieve distal bile duct obstruction in chronic pancreatitis?

Endoscopic placement of stents

What is the success rate of endoscopic therapy for chronic pancreatitis?

50%

What procedure provides pain relief in 80% of chronic pancreatitis cases?

Modified Puestow procedure

What is the risk associated with subtotal or total pancreatectomy with islet autotransplantation?

Risk of diabetes mellitus

What may reduce the risk of postoperative pancreatic fistulas?

Perioperative administration of somatostatin

When is endoscopic or surgical drainage indicated for pseudocysts in chronic pancreatitis?

For pseudocysts over 6 cm in diameter

How are pancreatic ascites or pancreaticopleural fistulas managed?

Endoscopic stent placement

What procedure may relieve pain in selected patients with chronic pancreatitis?

Pancreatic sphincterotomy

In what percentage of patients may percutaneous celiac plexus nerve block provide short-lived relief?

50%

What is reported to relieve refractory pain in chronic pancreatitis in a single session?

Radiation therapy to the pancreas

What is the main cause of death in chronic pancreatitis?

Pancreatic cancer

What is associated with poorer quality of life in chronic pancreatitis?

Constant pain

When should all patients with chronic pancreatitis be referred for diagnostic and therapeutic procedures?

All patients should be referred

What percentage of chronic pancreatitis cases are idiopathic?

10-30%

Which gene variant is NOT associated with genetic factors predisposing to chronic pancreatitis?

BRCA1

Which classification system for chronic pancreatitis includes 'Toxic-metabolic' as a category?

TIGAR-O

What hypothesis explains the pathogenesis of chronic pancreatitis by linking it to a first acute pancreatitis event?

SAPE hypothesis

What percentage of adults develop diabetes mellitus within 25 years after the clinical onset of chronic pancreatitis?

80%

Which of the following is NOT a clinical finding of chronic pancreatitis?

Tachycardia

What is the main cause of pain in chronic pancreatitis?

Impaired inhibitory pain modulation by the CNS

What symptom may occur late in the course of chronic pancreatitis?

Steatorrhea

What percentage of chronic pancreatitis cases are caused by obstructions in the pancreas?

20-30%

Which type of chronic pancreatitis is a complication of immune checkpoint inhibitor therapy?

Type 3

What is the main characteristic of chronic pancreatitis?

Chronic or recurrent episodes of acute pancreatitis

What intervention may resolve chronic pain in chronic pancreatitis?

Surgical intervention tailored to the cause of pain

Which test is recommended to confirm exocrine pancreatic insufficiency?

Response to secretin stimulation test

What is a detectable feature in about 40% of patients with chronic pancreatitis?

Vitamin B12 malabsorption

What is recommended for diagnosis and shows calcifications, ductal dilatation, and gland atrophy?

CT or MRI

Which imaging study is the most sensitive and may show dilated ducts, stones, strictures, or pseudocysts?

ERCP

What is the gold standard for diagnosis when imaging studies are inconclusive?

Histology

What is the basis for the diagnosis of autoimmune pancreatitis in the United States?

Imaging features

What are the complications of chronic pancreatitis?

Opioid addiction, brittle diabetes, pseudocyst or abscess

What imaging features are characteristic of autoimmune pancreatitis?

Diffuse enlargement and hypoattenuation

What is the most sensitive imaging study for chronic pancreatitis?

ERCP

What is the recommended test for confirming exocrine pancreatic insufficiency?

Response to pancreatic enzyme supplements

What is the gold standard for diagnosis when imaging studies are inconclusive?

Histology

What is the basis for the diagnosis of autoimmune pancreatitis in the United States?

Imaging features

Chronic pancreatitis occurs most often in patients with alcoholism.

True

Tobacco smoking is not a risk factor for idiopathic chronic pancreatitis.

False

About 2% of patients with hyperparathyroidism develop pancreatitis.

True

In tropical Africa and Asia, tropical pancreatitis is related in part to overnutrition.

False

Patients with hereditary pancreatitis have a 19% risk of pancreatic cancer by age 70.

True

Opioid addiction is common in chronic pancreatitis patients.

True

Exocrine pancreatic insufficiency is treated with pancreatic enzyme replacement therapy.

True

Antioxidant therapy has shown promise in inhibiting stress on the pancreas by toxic metabolites in some cases.

True

FDA-approved pancreatic enzyme preparations include Viokace, Creon, Ultresa, Zenpep, and Pancreaze.

True

Liver fibrosis may regress after biliary drainage in chronic pancreatitis patients.

True

Distal bile duct obstruction in chronic pancreatitis may be relieved by endoscopic placement of stents.

True

Endoscopic therapy or surgery may be indicated in chronic pancreatitis to treat complications, relieve obstruction, and attempt pain relief.

True

Chronic pancreatitis patients have a low risk of developing pancreatic cancer related to tobacco and alcohol use.

False

Autoimmune pancreatitis is primarily treated with surgical resection.

False

Chronic pancreatitis patients are advised to increase alcohol consumption for pain relief.

False

Chronic pancreatitis is commonly managed with a high-fat diet.

False

Serum amylase and lipase levels are always elevated during acute attacks of chronic pancreatitis.

False

Elevated alkaline phosphatase and bilirubin levels in chronic pancreatitis can result from bile duct compression.

True

Vitamin B12 malabsorption is rare in patients with chronic pancreatitis.

False

Genetic testing for major trypsinogen gene pathogenic variants is not recommended in younger patients with unclear etiology of chronic pancreatitis.

False

Endoscopic ultrasonographic criteria for chronic pancreatitis diagnosis include hypoechoic foci with shadowing.

False

ERCP is the most sensitive imaging study for chronic pancreatitis.

False

Histology is not considered the gold standard for diagnosis when imaging studies are inconclusive.

False

Autoimmune pancreatitis does not have characteristic imaging features.

False

The diagnosis of autoimmune pancreatitis in the United States is not based on the HISORt criteria.

False

Opioid addiction is not a complication of chronic pancreatitis.

False

Liver and bile duct issues are not complications of chronic pancreatitis.

False

Osteoporosis is not a complication of chronic pancreatitis.

False

Endoscopic therapy is successful in 80% of chronic pancreatitis cases

False

Subtotal or total pancreatectomy with islet autotransplantation is considered a first-line treatment for chronic pancreatitis

False

Perioperative administration of somatostatin or octreotide has no effect on the risk of postoperative pancreatic fistulas

False

Endoscopic or surgical drainage is indicated for symptomatic pseudocysts, especially those over 6 cm in diameter

True

Radiation therapy to the pancreas is a well-established method for relieving refractory pain in chronic pancreatitis

False

Chronic pancreatitis often leads to disability and reduced life expectancy, with pancreatic cancer as the main cause of death

True

Chronic pancreatitis is not associated with any specific risk factors

False

Percutaneous celiac plexus nerve block is considered ineffective for chronic pain and nondilated ducts

False

Management of chronic pancreatitis does not involve referral for diagnostic and therapeutic procedures for all patients

False

Chronic pancreatitis can be managed conservatively without the need for medical intervention

False

Management of chronic pancreatitis is not warranted for severe pain, new jaundice, or fever

False

Surgery is successful in 80% of cases for obstruction of the duodenal end of the pancreatic duct

False

Chronic pancreatitis can only be caused by obstructions like strictures, stones, or tumors in the pancreas.

False

Approximately half of early-onset chronic pancreatitis cases are predisposed by genetic factors.

True

The SAPE (Sentinel Acute Pancreatitis Event) hypothesis explains the pathogenesis of chronic pancreatitis.

True

Over 80% of adults develop diabetes mellitus within 25 years after the clinical onset of chronic pancreatitis.

True

Pain in chronic pancreatitis may vary over time, with a correlation with disease duration or imaging findings.

False

Steatorrhea, indicated by bulky, foul, fatty stools, may occur early in the course of chronic pancreatitis.

False

Surgical intervention is not effective in resolving chronic pain in chronic pancreatitis.

False

More than 80% of adults with chronic pancreatitis develop jaundice within 25 years after the clinical onset.

False

The TIGAR-O classification system for chronic pancreatitis does not include the category 'Recurrent and severe acute pancreatitis' as a cause.

False

Chronic pancreatitis often leads to disability and reduced life expectancy, with pancreatic cancer as the main cause of death.

True

Chronic pancreatitis is not a self-perpetuating disease and can be easily resolved with appropriate management.

False

Genetic factors predisposing to chronic pancreatitis include variants in the CFTR, PSTI (SPINK1), CTRC, CPA1, UGT1A7, PRSS1, CLDN2, and TRPV6 genes.

True

Chronic pancreatitis can only be caused by obstructions like strictures, stones, or tumors in the pancreas

False

Approximately 50% of early-onset chronic pancreatitis cases are predisposed by genetic factors

True

TIGAR-O classification system for chronic pancreatitis includes 'Recurrent and severe acute pancreatitis' as a category

True

Chronic pancreatitis is not a self-perpetuating disease

False

Over 80% of adults develop diabetes mellitus within 15 years after the clinical onset of chronic pancreatitis

False

Pain in chronic pancreatitis has no correlation with disease duration or imaging findings

True

Steatorrhea may occur early in the course of chronic pancreatitis

False

Surgical intervention tailored to the cause of pain may not resolve chronic pain in chronic pancreatitis

False

Chronic pancreatitis is not characterized by chronic or recurrent episodes of acute pancreatitis

False

Chronic pancreatitis can be caused by autoimmune factors

True

M-ANNHEIM classification system for chronic pancreatitis includes 'pancreatitis with multiple risk factors' as a category

True

Chronic pancreatitis cannot be a complication of immune checkpoint inhibitor therapy

False

Match the following risk factors with their association to chronic pancreatitis:

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

Match the imaging findings with their association to chronic pancreatitis:

Calcifications = Recommended for diagnosis Ductal dilatation = Characteristic feature Gland atrophy = Characteristic feature Pancreatic steatosis = Can lead to exocrine and endocrine insufficiency

Match the classification systems with their inclusion for chronic pancreatitis:

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

Match the medical interventions with their potential impact on chronic pancreatitis:

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

Match the risk factor with the associated increased risk of pancreatic cancer:

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

Match the medical measure with its associated management for chronic pancreatitis:

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

Match the FDA-approved pancreatic enzyme preparation with its name:

Viokace = FDA-approved pancreatic enzyme preparations Creon = FDA-approved pancreatic enzyme preparations Ultresa = FDA-approved pancreatic enzyme preparations Zenpep = FDA-approved pancreatic enzyme preparations

Match the management option with its indication in chronic pancreatitis:

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

Match the following diagnostic tests with their indications in chronic pancreatitis:

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

Match the following complications with their association in chronic pancreatitis:

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

Match the following statements with their correct association in chronic pancreatitis:

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

Match the following management interventions with their efficacy in chronic pancreatitis:

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

Match the following interventions for reducing postoperative pancreatic fistulas with their effectiveness:

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

Match the following management approaches for specific complications of chronic pancreatitis with their indications:

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

Match the genetic factor with its association with chronic pancreatitis:

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

Match the classification system with its components for chronic pancreatitis:

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

Match the clinical finding with its association with chronic pancreatitis:

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

Match the statement with its association with chronic pancreatitis:

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

Match the risk factor with the associated increased risk of chronic pancreatitis:

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

Match the region with the most common cause of chronic pancreatitis:

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

Match the imaging finding with its association with chronic pancreatitis:

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

Match the complication with its association with chronic pancreatitis:

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

Match the risk factor with its associated risk of pancreatic cancer:

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

Match the medical measure with its indication in chronic pancreatitis:

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

Match the FDA-approved pancreatic enzyme preparation with its name:

Viokace = FDA-approved pancreatic enzyme preparation Creon = FDA-approved pancreatic enzyme preparation Ultresa = FDA-approved pancreatic enzyme preparation Zenpep = FDA-approved pancreatic enzyme preparation

Match the procedure with its indication in chronic pancreatitis:

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

Match the statement with its correct association with chronic pancreatitis:

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

Match the imaging finding with its association to chronic pancreatitis:

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

Match the intervention with its potential impact on chronic pancreatitis:

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

Match the management with the complication of chronic pancreatitis:

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

Match the impact on quality of life with associated factors in chronic pancreatitis:

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

Match the procedure with its potential impact on chronic pancreatitis:

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

Match the genetic factor with its association with chronic pancreatitis:

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

Match the classification system with its components for chronic pancreatitis:

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

Match the risk factor with its association with chronic pancreatitis:

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

Match the medical measure with its associated management for chronic pancreatitis:

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

Match the imaging study with its features in chronic pancreatitis diagnosis:

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

Match the complication with its association in chronic pancreatitis:

Opioid addiction = Complication of chronic pancreatitis Brittle diabetes = Complication of chronic pancreatitis Pseudocyst or abscess = Complication of chronic pancreatitis Malnutrition = Complication of chronic pancreatitis

Match the diagnostic feature with its association in chronic pancreatitis:

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

Match the diagnosis criterion with its characteristic in chronic pancreatitis:

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

Study Notes

Chronic Pancreatitis Overview

  • Chronic pancreatitis can be caused by obstructions like strictures, stones, or tumors in the pancreas, autoimmune factors, immune checkpoint inhibitor therapy, or idiopathic reasons
  • It can be classified into type 1 (multisystem disease), type 2 (affects pancreas alone), and type 3 (a complication of immune checkpoint inhibitor therapy)
  • Approximately 10-30% of chronic pancreatitis cases are idiopathic, with genetic factors predisposing nearly half of early-onset cases and a quarter of late-onset cases
  • Genetic factors include variants in the CFTR, PSTI (SPINK1), CTRC, CPA1, UGT1A7, PRSS1, CLDN2, and TRPV6 genes
  • Classification systems for chronic pancreatitis include TIGAR-O (Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis, or Obstructive) and M-ANNHEIM (pancreatitis with multiple risk factors)
  • The 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 is a self-perpetuating disease characterized by chronic or recurrent episodes of acute pancreatitis and ultimately by pancreatic insufficiency
  • Over 80% of adults develop diabetes mellitus within 25 years after the clinical onset of chronic pancreatitis
  • Clinical findings of chronic pancreatitis include persistent or recurrent epigastric and left upper quadrant pain, anorexia, nausea, vomiting, constipation, flatulence, weight loss, tenderness over the pancreas, mild muscle guarding, ileus, and steatorrhea
  • Pain results from impaired inhibitory pain modulation by the CNS and may vary over time, with no correlation with disease duration or imaging findings
  • Steatorrhea, indicated by bulky, foul, fatty stools, may occur late in the course of chronic pancreatitis
  • Surgical intervention tailored to the cause of pain may resolve chronic pain in chronic pancreatitis

Diagnosis and Complications of Chronic Pancreatitis

  • Serum amylase and lipase may be elevated during acute attacks, but normal values do not exclude the diagnosis.
  • Elevated alkaline phosphatase and bilirubin levels can result from bile duct compression.
  • Exocrine pancreatic insufficiency is confirmed by response to pancreatic enzyme supplements or secretin stimulation test.
  • Vitamin B12 malabsorption is detectable in about 40% of patients, but clinical deficiency is rare.
  • Genetic testing for major trypsinogen gene pathogenic variants is recommended in younger patients with unclear etiology.
  • Imaging with CT or MRI is recommended for diagnosis, showing calcifications, ductal dilatation, and gland atrophy.
  • Endoscopic ultrasonographic criteria for chronic pancreatitis diagnosis include hyperechoic foci with shadowing.
  • ERCP is the most sensitive imaging study and may show dilated ducts, stones, strictures, or pseudocysts.
  • Histology is the gold standard for diagnosis when imaging studies are inconclusive.
  • Autoimmune pancreatitis has characteristic imaging features including diffuse enlargement, hypoattenuation, and irregular narrowing of the main pancreatic duct.
  • The diagnosis of autoimmune pancreatitis in the United States is based on the HISORt criteria.
  • Complications of chronic pancreatitis include opioid addiction, brittle diabetes, pseudocyst or abscess, liver and bile duct issues, exocrine insufficiency, malnutrition, osteoporosis, and peptic ulcer.

Chronic Pancreatitis Overview

  • Chronic pancreatitis can be caused by obstructions like strictures, stones, or tumors in the pancreas, autoimmune factors, immune checkpoint inhibitor therapy, or idiopathic reasons
  • It can be classified into type 1 (multisystem disease), type 2 (affects pancreas alone), and type 3 (a complication of immune checkpoint inhibitor therapy)
  • Approximately 10-30% of chronic pancreatitis cases are idiopathic, with genetic factors predisposing nearly half of early-onset cases and a quarter of late-onset cases
  • Genetic factors include variants in the CFTR, PSTI (SPINK1), CTRC, CPA1, UGT1A7, PRSS1, CLDN2, and TRPV6 genes
  • Classification systems for chronic pancreatitis include TIGAR-O (Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis, or Obstructive) and M-ANNHEIM (pancreatitis with multiple risk factors)
  • The 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 is a self-perpetuating disease characterized by chronic or recurrent episodes of acute pancreatitis and ultimately by pancreatic insufficiency
  • Over 80% of adults develop diabetes mellitus within 25 years after the clinical onset of chronic pancreatitis
  • Clinical findings of chronic pancreatitis include persistent or recurrent epigastric and left upper quadrant pain, anorexia, nausea, vomiting, constipation, flatulence, weight loss, tenderness over the pancreas, mild muscle guarding, ileus, and steatorrhea
  • Pain results from impaired inhibitory pain modulation by the CNS and may vary over time, with no correlation with disease duration or imaging findings
  • Steatorrhea, indicated by bulky, foul, fatty stools, may occur late in the course of chronic pancreatitis
  • Surgical intervention tailored to the cause of pain may resolve chronic pain in chronic pancreatitis

Chronic Pancreatitis Overview

  • Chronic pancreatitis can be caused by obstructions like strictures, stones, or tumors in the pancreas, autoimmune factors, immune checkpoint inhibitor therapy, or idiopathic reasons
  • It can be classified into type 1 (multisystem disease), type 2 (affects pancreas alone), and type 3 (a complication of immune checkpoint inhibitor therapy)
  • Approximately 10-30% of chronic pancreatitis cases are idiopathic, with genetic factors predisposing nearly half of early-onset cases and a quarter of late-onset cases
  • Genetic factors include variants in the CFTR, PSTI (SPINK1), CTRC, CPA1, UGT1A7, PRSS1, CLDN2, and TRPV6 genes
  • Classification systems for chronic pancreatitis include TIGAR-O (Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis, or Obstructive) and M-ANNHEIM (pancreatitis with multiple risk factors)
  • The 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 is a self-perpetuating disease characterized by chronic or recurrent episodes of acute pancreatitis and ultimately by pancreatic insufficiency
  • Over 80% of adults develop diabetes mellitus within 25 years after the clinical onset of chronic pancreatitis
  • Clinical findings of chronic pancreatitis include persistent or recurrent epigastric and left upper quadrant pain, anorexia, nausea, vomiting, constipation, flatulence, weight loss, tenderness over the pancreas, mild muscle guarding, ileus, and steatorrhea
  • Pain results from impaired inhibitory pain modulation by the CNS and may vary over time, with no correlation with disease duration or imaging findings
  • Steatorrhea, indicated by bulky, foul, fatty stools, may occur late in the course of chronic pancreatitis
  • Surgical intervention tailored to the cause of pain may resolve chronic pain in chronic pancreatitis

Diagnosis and Complications of Chronic Pancreatitis

  • Serum amylase and lipase may be elevated during acute attacks, but normal values do not exclude the diagnosis.
  • Elevated alkaline phosphatase and bilirubin levels can result from bile duct compression.
  • Exocrine pancreatic insufficiency is confirmed by response to pancreatic enzyme supplements or secretin stimulation test.
  • Vitamin B12 malabsorption is detectable in about 40% of patients, but clinical deficiency is rare.
  • Genetic testing for major trypsinogen gene pathogenic variants is recommended in younger patients with unclear etiology.
  • Imaging with CT or MRI is recommended for diagnosis, showing calcifications, ductal dilatation, and gland atrophy.
  • Endoscopic ultrasonographic criteria for chronic pancreatitis diagnosis include hyperechoic foci with shadowing.
  • ERCP is the most sensitive imaging study and may show dilated ducts, stones, strictures, or pseudocysts.
  • Histology is the gold standard for diagnosis when imaging studies are inconclusive.
  • Autoimmune pancreatitis has characteristic imaging features including diffuse enlargement, hypoattenuation, and irregular narrowing of the main pancreatic duct.
  • The diagnosis of autoimmune pancreatitis in the United States is based on the HISORt criteria.
  • Complications of chronic pancreatitis include opioid addiction, brittle diabetes, pseudocyst or abscess, liver and bile duct issues, exocrine insufficiency, malnutrition, osteoporosis, and peptic ulcer.

Test your knowledge of chronic pancreatitis with this comprehensive quiz covering its causes, classifications, genetic factors, diagnostic criteria, and associated complications. Assess your understanding of the disease's pathogenesis, clinical findings, and diagnostic tools, including imaging and genetic testing.

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