Predictors of Malignancy in Chronic Pancreatitis.

Selvakumar, E (2007) Predictors of Malignancy in Chronic Pancreatitis. Masters thesis, Stanley Medical College, Chennai.


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INTRODUCTION : Chronic pancreatitis is a condition characterised by irreversible destruction and fibrosis of the exocrine parenchyma, leading to exocrine pancreatic insufficiency and progressive endocrine failure leading to diabetes. Alcoholic chronic pancreatitis is the commonest type of chronic pancreatitis seen in the western world, while in the tropics there is a distinct non-alcoholic type of chronic pancreatitis of uncertain aetiology, which is far more common. Several names have been proposed for this type of chronic pancreatitis including tropical chronic pancreatitis (TCP), tropical calcific pancreatitis, juvenile pancreatitis syndrome, Afro-Asian pancreatitis, and fibrocalculous pancreatic diabetes. TCP can be defined as a juvenile form of chronic calcific non-alcoholic pancreatitis prevalent almost exclusively in the developing countries of the tropical world. Some of its distinctive features are younger age at onset, presence of large intraductal calculi, an accelerated course of the disease leading the end points of diabetes and/or steatorrhoea, and a high susceptibility to pancreatic cancer. Kini reported the first case of pancreatic calculi from India in 1937 and this was followed by reports of pancreatic calculi observed at postmortem from Vellore in southern India. However, it was after Geevarghese, one of the pioneers in the field, documented one of the largest series in the world from Kerala state in Southern India that TCP attracted International attention. AIM OF THE STUDY : The aim of the study was to A. Prospectively analyse the mass lesion arising in the background of chronic pancreatitis clinically, biochemically & radiologically. B. To identify the predictors of malignancy in patients with chronic pancreatitis without a tissue diagnosis. METHODS : Between August 2004 to February 2007, 32 patients who presented with chronic pancreatitis and mass lesion to the Department of Surgical Gastroenterology, Government Stanley Hospital, Chennai were included for the study. Among these 10 were due to Alcoholic pancreatitis and 22 were due to Tropical calcific pancreatitis (TCP). Alcoholic chronic pancreatitis was defined as chronic pancreatitis associated with the consumption of greater than 50 units of alcohol per week for atleast 5 years. TCP was defined as non-alcoholic pancreatitis with features of younger age at onset, presence of large intraductal calculi, an accelerated course of the disease leading to the end points of diabetes and/or steatorrhoea.Detailed history was obtained from all patients. CONCLUSION : In the appropriate clinical setting, a patient with sudden worsening of abdominal pain with S.Bilirubin > 6.5 mg%, CA 19-9>114 U/ml, MPD>13.5 mm, CBD>16 mm & multiple Intrapancreatic cystic lesions should be strongly considered to have malignancy.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Predictors ; Malignancy ; Chronic Pancreatitis.
Subjects: MEDICAL > Surgical Gastroenterology and Proctology
Depositing User: Kambaraman B
Date Deposited: 28 Jul 2017 02:52
Last Modified: 28 Jul 2017 02:52

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