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Chronic Pancreatitis

Chronic Pancreatitis

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Published by Louis Fortunato

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Published by: Louis Fortunato on Mar 20, 2012
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01/18/2013

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Chronic PancreatitisICD-9M Code577.1 Chronic Pancreatitis1. Etiology:A. Alcoholism: Most Common Cause of Exocrine Pancreatic InsufficiencyIn Adults In The USAB. Cystic Fibrosis:C. Acute Pancreatitis Causes Of Recurrent Episodes Of PancreaticInflammation As Seen In Chronic Relapsing PancreatitisD. Idiopathic2. Pathology:A. Extensive Pancreatic FibrosisB. With Extensive Atrophy Of The Exocrine Glands And SometimesRemarkable Sparing Of The Islets Of Langherans.C. Chronic Inflammatory Infiltrate Around the Lobules And Ducts3. Clinical Presentation:A. Often A Long Term History of AlcoholismB. Persistent Upper Abdominal Epigastric Pain That Radiates To The Back C. Pain is Now Constant Epigastric Pain Worsened By Alcohol Ingestion Or Fatty FoodsD. Steatorhea: Foul Smelling Loose Bulky Greasy StoolsE. Weight Loss: Often Over 20 PoundsF. Cachetic LookingG. Jaundice (Secondary to Edema and Fibrosis At The Head Of ThePancreas Causing Common Bile Duct Obstruction)H. Epigastric Tenderness Without Rebound Or Rigidity
 
4. Laboratory Findings:A. Decreased HematocritB. Megaloblastic AnemiaC. HypocalcemiaD. Low Vitamin B12 LevelsE. Impaired Glucose IntoleranceF. Low Serum Cholesterol (Due To Malabsorption)G. Normal Lipase and Amylase LevelsH .Decreased Serum Trypsinogen LevelsI Reduced Pancreatic Enzyme SecretionJ. Increased Fecal Fat On Stool Examination5. Imaging Studies:A.KUB:A. Multiple Calcifications In The Distribution Of The PancreasB. CT:1. Chain of Lakes Deformity: Deformity of the Pancreatic DuctsCaused By Many Areas Of Strictures With Intervening Areas Of DilationC.ERCP:1. A Dilated And Irregular Pancreatic Duct.
 
6. Rx:1. Abstain From Alcohol2. NSAIDs For Pain3. Vitamin Supplements4. Pancreatic Enzyme Supplementation(Pancrease) With Antacids For Malabsorption5. Insulin : For Those Who Develop Diabetes Mellitus6. Octreotide 200 ug SC TID For Pain In Idiopathic Chronic Pancreatitis7. Consider Surgery : For Intractable PainChronic Rx:1. Surgical Intervention To Eliminate Biliary Tract DiseaseAnd Improve Bile Flow Into The Duodenum By Elimination Of AnObstructed Pancreatic Duct2. ERCP: With Endoscopic Sphincterotomy For Removal Of Gallstones3. Selected Patients:A. PancreaticojejunostomyB. Transduodenal Sphincteroplasty7. Complications:A. Diabetes MellitusB. Pancreatic Exocrine InsufficiencyC. Pancreatic Cancer D. Pancreatic PseudocystsE. Pancreatic AbscessesF. Common Bile Duct Or Duodenal ObstructionG. Splenic Vein ThrombosisH. AscitesI. Pleural EffusionsJ. Narcotic Dependency For Pain : May Become An Issue

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