Chronic Pancreatitis



Definition: A pathologic fibroinflammatory syndrome of the pancreas in individuals with genetic, environmental, and/or other risk factors who develop persistent

pathologic responses to parenchymal injury or stress.

60% of CP cases evolved from acute pancreatitis and recurrent acute pancreatitis (RAP), whereas about 10% of acute pancreatitis and 30% of RAP progress to CP



Etiology of CP - TIGAR-O system:

 • T (Toxic-Metabolic)

 • I (Idiopathic)

 • G (Genetic)

 • A (Autoimmune)

 • R (Recurrent acute or severe pancreatitis)

 • O (Obstructive)



Diagnosis:

 • 1st line: CT or MRI

 • 2nd line: EUS only if diagnosis is in question after cross-sectional imaging

 • 3rd line: secretin-enhanced MRCP if diagnosis in question after cross-sectional imaging or EUS

 • 4th line: histologic diagnosis with EUS-guided FNA (low sensitivity)



Clinical Manifestations:

 • Abdominal pain

 • Fat-soluble vitamin deficiency -> malnutrition/osteoporosis

 • Risk of pancreatic malignancy

 • Endocrine insufficiency manifesting as DM



By Amneet Hans, MD @amneethansmd via @EmoryGastroHep



#Chronic #Pancreatitis #diagnosis #management #gastroenterology #treatment