means obviously increased
duration of injury.
Is it possible that you might
have acute, acute, acute, acute?
Or should I say a number of
acute bouts of pancreatitis and
at some point you have to
call it chronic pancreatitis?
Isn’t that pretty much the same reasoning
that we gave or we transitioned from
what’s known as your pyelonephritis
acute type into chronic pyelonephritis?
Recurrent, recurrent, acute.
One definition, but let’s go further.
So the persistent
inflammation of the pancreas
where now it’s irreversible
and without a doubt, the
pancreas is completely exhausted
to the point where the patient
doesn’t have either the
exocrine enzyme activity nor
have the endocrine activity.
So for example,
what was the name of the
enzyme that’s more specific
for pancreatic damage
that you’re going to use?
In chronic pancreatitis,
if it’s persistent inflammation
and there’s enough damage
taking place in the pancreas,
please understand that now the
lipase and amylase is unreliable.
What about that glucose, endocrine?
So if insulin is not
present, your patient
most likely is presenting
Cardinal symptom, recurrent abdominal
pain, recurrent abdominal pain.
Classic triad, with chronic pancreatitis,
no doubt you’re going to
Next, without a doubt,
because you don’t have the lipase
to properly break down my triglyceride,
you’re going to end up finding
lipid in my stool.
Welcome to steatorrhea.
And because of destruction of
pancreas, loss of insulin,
there will be hyperglycemia welcome to
acquired type of diabetes mellitus.
Also, results in weight loss and
malnutrition, be careful with that though
because as a differential, you should also
be thinking about pancreatic cancer, right?
But what I’m saying is you
can find weight loss and
malnutrition taking place even
with chronic pancreatitis.
and the symptoms here will
give exactly that and I’ll
give you pancreatic cancer
and what you’re looking for.
Okay. Etiology of chronic pancreatitis.
Here once again. Yes.
Because you have an alcoholic, sure that
alcoholic is having an acute pancreatitis.
Is he gonna stop? Is he or
she going to stop drinking?
Chances are pretty slim
that he or she will not.
They’ll continue drinking. “Ouch again!”
Another acute bout.
“Oh, yet again an acute bout.”
You keep having recurrent
bouts of acute pancreatitis.
By definition, isn’t that
By definition, isn’t that
It correlates with the amount and
duration of alcohol with pancreatitis.
Increased IgG IV with the
association to autoimmune diseases.
So in general whenever there’s going to
be autoimmune disease over a period time,
you are going to cause
damage to the pancreas.
Increased risk of pancreatic cancer with
hereditary type of chronic pancreatitis.
in third world countries.
Meaning to say that here, with over a
long period of time metabolically,
Protein-calorie malnutrition in
third world countries is a problem.
We’ve talked about pancreatic divisum.
There might be issues with trauma
or maybe even ductal disruption.
We talked about things such
as your pancreatic stones
or a gallstone which has made
its way down to the pancreas.
The space occupying lesion here
once again could be a tumor
and that will be obstructive.
Common differentials or
differentials that you want to
keep in mind depending as
you who your population is.