CHRONIC PANCREATITIS


This was a 42-year-old gentleman , a known case of Insulin dependant Diabetes Mellitus. He was being evaluated by his physician for loss of weight and abdominal pain of a few months duration.

His abdominal ultrasound pictures are given below.

ABD CHR PANCREATITIS _2

 

 

ABD CHR PANCREATITIS _3

 

 

ABD CHR PANCREATITIS _4

 

 

ABD CHR PANCREATITIS _5

ABD CHR PANCREATITIS _6

The following pictures show the pancreas.

 

ABD CHR PANCREATITIS _7 ABD CHR PANCREATITIS _8

Pancreatic duct is dilated prominently.

 

ABD CHR PANCREATITIS _9

 

 

ABD CHR PANCREATITIS _10

Pancreatic duct dilated.- 12.9 mms.

 

ABD CHR PANCREATITIS _11 ABD CHR PANCREATITIS _12

 

 

ABD CHR PANCREATITIS _13

Pancreatic calculi are seen.

 

ABD CHR PANCREATITIS _14

 

 

ABD CHR PANCREATITIS _15

 

 

ABD CHR PANCREATITIS _16 ABD CHR PANCREATITIS _17 ABD CHR PANCREATITIS _18

 

 

This patient further underwent Upper G.I. endoscopy , which was normal and later MRI scan , which confirmed the ultrasound findings. He was conservatively managed and is clinically better.

This patient had no history of alcoholism . He does not fit into a classical Tropical Pancreatitis or Fibrocalculous Pancreatic Diabetes.

 Diagnostic criteria for fibro-calculous pancreatic diabetes (FCPD) 
1. Occurrence in a “tropical” country.
2. Diabetes by WHO Study Group [1] criteria.
3. Evidence of chronic pancreatitis: pancreatic calculi on X-ray or at least three of the following:
a) Abnormal pancreatic morphology by sonography
b) Chronic abdominal pain since childhood
c) Steatorrhoea
d) Abnormal pancreatic function test.
4. Absence of other causes of chronic pancreatitis. i.e. alcoholism, hepatobiliary disease or primary hyper parathyroidism

 This patient did not have any abdominal pain until recently .But the other features would probably fit into  the diagnosis.

http://mdrf-eprints.in/305/1/fcpd.pdf

http://www.ipans.org/publications/chapter7.pdf

http://emedicine.medscape.com/article/181554-overview#showall

 

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