CLASS 4 : CHRONIC PANCREATITIS
TASK 1
Patient, 44 years old, was admitted to hospital
complaining of time to time left hypochondriac region
pain, weight sensation in the epigastric area and
additional mass presence. 6 months ago he was
treated conservatively due to acute pancreatitis. 2
months later he has paid attention to not severe pain
presence in the left hypochondriac region in
accompaniment with the appearance of painless,
immobile masses.
1. Preliminary diagnosis.
Chronic relapsing pancreatitis.
[Link] of investigations.
Laboratory Investigations
Full blood count – Leukocytosis, slight elevation of ESR
Blood glucose test – Increased sugar ( to find out DM )
Biochemical blood test – Increase amylase, decrease
lipase, increase CRP
Urinalysis
Instrumental Investigations
Ultrasound of abdomen – Edema of pancreas ( pancreatic
duct, size of pancreas, ascites )
Duodenoscopy – better visualization of papilla vater
CT – necrotization of Pancreas
ERCP ( endoscopic retrograde
cholangiopancreatography ) – To identify stenosis of
ducts, local obstruction
[Link].
Proton pump inhibitors
Prokinetics – domperidone
Myotropic spasmolytics – Odeston
Supplements of enzymes – Creon ( pancreatic lipase ),
Panzyme (pepsin and vitamin B6 )
Non-narcotic analgesics ( paracetamol ) – for pain
management
Prior to surgery – Sandostatin ( to not produce pancreatic
juice)
Surgical treatment
Resection of pancreas
Puestow procedure – draining pancreas by draining the
pancreatic duct into small intestine
Depending on localization – Whipple procedure ( for
head of pancreas ), Distal pancreatectomy ( tail and body
)
Palliative operation - cryodestruction
TASK 2
A 42-year-old patient complains of acute girdle pains
in the epigastric region that occur after any meal,
especially after fatty and spicy foods. Concerned
about nausea, vomiting at the height of pain, which
does not bring relief. After eating - severe bloating,
rumbling. Defecating 3-4 times a day, plentiful, shiny,
with a pungent smell of rancid oil and rotten meat.
The state of moderate severity. Body temperature
37.9 °. The abdomen is distended, participates in
respiration, there is no muscle tension, there are no
symptoms of peritoneal irritation. Positive symptom
of Kacha on the left. A sharp pain at the Mayo-
Robson point is determined. Amylase in the blood -
798. With ultrasound, the pancreas is increased by 8
mm in the tail region and 12 mm in the head region
due to edema.
1. Preliminary diagnosis.
Acute pancreatitis – in stage of exacerbation
[Link] of investigations.
Laboratory Investigations
Full blood count – Leukocytosis, slight elevation of ESR
Blood glucose test – Increased sugar ( to find out DM )
Biochemical blood test – Increase amylase, decrease
lipase, increase CRP
Urinalysis
Instrumental Investigations
Ultrasound of abdomen – Edema of pancreas ( pancreatic
duct, size of pancreas, ascites )
Duodenoscopy – better visualization of papilla vater
CT – necrotization of Pancreas
ERCP ( endoscopic retrograde
cholangiopancreatography ) – To identify stenosis of
ducts, local obstruction
[Link].
Proton pump inhibitors
Prokinetics – domperidone
Myotropic spasmolytics – Odeston
Supplements of enzymes – Creon ( pancreatic lipase ),
Panzyme (pepsin and vitamin B6 )
Non-narcotic analgesics ( paracetamol ) – for pain
management
Prior to surgery – Sandostatin ( to not produce pancreatic
juice)
Surgical treatment
Resection of pancreas
Puestow procedure – draining pancreas by draining the
pancreatic duct into small intestine
Depending on localization – Whipple procedure ( for
head of pancreas ), Distal pancreatectomy ( tail and body
)
Palliative operation - cryodestruction
Therapeutic ERCP for ampullary obstruction.
TASK 3
The patient 45 years old patient was admitted to
hospital with complaints for relapsing severe pain in
the epigastric region with back irradiation after
alcohol drinking, weight loss, diarrhea. 10 years ago
he was operated upon due to necrotising pancreatitis.
Objectively – no any signs of acute abdominal
surgical pathology. In laboratory investigation – no
signs of acute inflammatory changes in blood,
steatorrhea, creatorrhea in stool examination.
1. Preliminary diagnosis.
Chronic relapsing pancreatitis.
[Link] of investigations.
Laboratory Investigations
Full blood count – Leukocytosis, slight elevation of ESR
Blood glucose test – Increased sugar ( to find out DM )
Biochemical blood test – Increase amylase, decrease
lipase, increase CRP
Urinalysis
Instrumental Investigations
Ultrasound of abdomen – Edema of pancreas ( pancreatic
duct, size of pancreas, ascites )
Duodenoscopy – better visualization of papilla vater
CT – necrotization of Pancreas
ERCP ( endoscopic retrograde
cholangiopancreatography ) – To identify stenosis of
ducts, local obstruction
Pancreatic ultrasound
[Link].
Proton pump inhibitors
Prokinetics – domperidone
Myotropic spasmolytics – Odeston
Supplements of enzymes – Creon ( pancreatic lipase ),
Panzyme (pepsin and vitamin B6 )
Non-narcotic analgesics ( paracetamol ) – for pain
management
Prior to surgery – Sandostatin ( to not produce pancreatic
juice)
Surgical treatment
Resection of pancreas
Puestow procedure – draining pancreas by draining the
pancreatic duct into small intestine
Depending on localization – Whipple procedure ( for
head of pancreas ), Distal pancreatectomy ( tail and body
)
Palliative operation - cryodestruction
Therapeutic ERCP for ampullary obstruction.