Chronic Pancreatitis
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Chronic pancreatitis
-Hx of recurrent pancreatitis due to ETOH use vs autoimmune vs idiopathic vs obstruction.
-Endorsing epigastric pain, nausea, vomiting, and/or steatorrhea.
-Obtain CBC, BMP, LFTs, lipase, amylase, lipid panel and a fecal-elastase-1 value.
-If no hx of alcoholism and chronic autoimmune pancreatitis is suspected, will order ESR, CRP ANA, RF, antibodies, and igg4. If autoimmune pancreatitis, will need steroids and immunomodulators.
-Will obtain CT abdomen to assess pancreas morphology & exclude other pathologies, if not already done.
-If CT is normal, will obtain MRCP. Will consider Secretin stimulated MRCP to define subtle changes in the ducts & help assess ductal compliance and exocrine function.
-Start/ continue pancreatic replacement/ pancrelipase.
-Pain control with analgesia (NSAID/pregabalin/TCA). Will avoid opioid, may benefit from celiac nerve plexus block post discharge.
-Counselled on alcohol + tobacco cessation. Counselled on low fat diet.
-Surgery/GI consult. May benefit from pancreatic resection but >10% operative mortality.
-Monitor for splenic vein thrombosis, pseudocyst formation, diabetes, and pancreatic cancer.
-Appointment made for PCP and GI f/u post discharge.
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