What is the likely diagnosis?
What is the treatment?
The X-ray shows calcification in the area of the pancreas which would support a diagnosis of chronic pancreatitis.
The treatment is CREON pancreatic enzymes which prevents the malabsorption associated with pancreatic insufficiency.
Management:
Treat underlying cause to prevent progression
Focus on nutrition, samll meal portions, low fat
Stop smoking ( smoking speed up progression and increase risk of pancreatic cancer)
Management of chronic pain
PERT for exocrine insufficiency, insulin for diabetes
By definition, an episode of pancreatitis is considered chronic pancreatitis if:
ReplyDelete1-It is a recurrent episode.
2-It occurs in the face of alcohol use.
3-There are radiographic findings of ductal irregularity and parenchymal fibrosis.
4-It is associated with steatorrhea.
5-A pseudocyst is present.
Chronic pancreatitis is a persistent or progressive disorder in which changes in pancreatic structure and function usually precede symptoms and always persist even after the precipitating cause of pancreatitis has been corrected. The only way to confirm that an attack of pancreatitis can be categorized as chronic pancreatitis is to demonstrate the findings consistent with chronic pancreatitis including ductal irregularity and parenchymal fibrosis. Acute pancreatitis may be recurrent and may occur in the face of alcohol use and steatorrhea. Pseudocysts can be seen in both acute and chronic pancreatitis.
Which of the following is true in the pathogenesis of chronic pancreatitis?
ReplyDelete1-There is accumulation of damaging lipid granules in pancreatic stellate cells.
2-Chronic alcohol use decreases protein content of pancreatic secretions.
3-There is disorientation of acinar cell secretory function.
4-There is migration of ductal cells into the acini.
Among the hypothesized pathophysiologic mechanisms in chronic pancreatitis, the secretion of pancreatic enzyme precursors is altered such that the enzymes are secreted at the basolateral membrane of the acinar cells rather than at the apical location. This secretion in turn causes local damage and acinar cell necrosis. Pancreatic secretions in chronic pancreatitis are protein rich and lack adequate bicarbonate, causing increased viscosity and obstruction of the ducts. Stellate cells become activated, lose their lipid granules, and propagate a fibrotic response. Pancreatic ductal cells may also be damaged and exhibit degrees of metaplasia and fibrosis.
1
DeleteWhich of the following histologic features is most specific for chronic pancreatitis?
ReplyDelete1-Acinar cell necrosis
2-Ductular plugging
3-Fat necrosis
4-Interlobular fibrosis
5-Parenchymal hemorrhage
Fat necrosis and acinar cell necrosis are hallmarks of acute pancreatitis and may be seen in those with chronic pancreatitis. Lobular hemorrhage also occurs commonly in acute pancreatic injury. Ductular plugs may be seen in CF and chronic pancreatitis. Fibrotic changes to the lobules and parenchymal atrophy are features of chronic pancreatitis.
4
DeleteI was diagnosed as HEPATITIS B carrier in 2013 with fibrosis of the
ReplyDeleteliver already present. I started on antiviral medications which
reduced the viral load initially. After a couple of years the virus
became resistant. I started on HEPATITIS B Herbal treatment from
ULTIMATE LIFE CLINIC (www.ultimatelifeclinic.com) in March, 2020. Their
treatment totally reversed the virus. I did another blood test after
the 6 months long treatment and tested negative to the virus. Amazing
treatment! This treatment is a breakthrough for all HBV carriers.