In this educational video, experts from Cincinnati Children’s Pancreas Care Center discuss the complexities of diagnosing and managing chronic pancreatitis. Dr. Maisam Abu-El-Haija and Dr. Andrew Trout cover the condition’s impact on pancreatic function, imaging techniques, genetic testing, and treatment options.
Key Topics:
What is Chronic Pancreatitis? A progressive inflammatory condition leading to fibrosis, loss of pancreatic function, and complications like diabetes and malnutrition.
Diagnosis: The role of imaging (MRI, CT) and genetic testing in identifying and understanding the disease.
Treatment Strategies: From nutritional management and pancreatic enzyme replacement to endoscopic therapy and a multidisciplinary approach to pain management.
Pain Management: A stepwise approach involving pain specialists, psychologists, and physical therapists to address both the physical and emotional aspects of chronic pain.
Learn how the team at Cincinnati Children’s is transforming care for patients with chronic pancreatitis through innovative techniques and a comprehensive, patient-centered approach.
Type: video · 8 min · posted 2024-11-19 Canonical: https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440 ## Chapters - [0:00](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=0) Introduction and Definition of Chronic Pancreatitis - [1:41](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=101) Diagnosis and Imaging Modalities - [3:41](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=221) Genetic Testing - [4:29](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=269) Consequences and Complications - [5:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=315) Treatment Approaches ## Statements - "Chronic pancreatitis is a chronic inflammatory condition where inflammation over time results in damage and destruction of the pancreas with replacement of healthy tissue with fibrosis" — Maisaabel Haija (clinical) [0:34](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=34) - "Ongoing pancreatic damage affects acinar cells, ductal cells, and islet cells which are responsible for producing insulin" (clinical) [0:54](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=54) - "When islet cells are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes" (clinical) [1:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=85) - "Chronic pancreatitis is a progressive inflammatory disorder that results in irreversible loss of pancreatic function" (clinical) [1:33](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=93) - "Diagnosis of chronic pancreatitis mostly relies on imaging findings" — Maisaabel Haija (clinical) [1:43](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=103) - "Diagnosis involves identifying calcifications, ductal obstruction, or dilation combined with one of three criteria: pain consistent with pancreatic origin, exocrine dysfunction, or endocrine dysfunction" — Maisaabel Haija (guideline) [1:48](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=108) - "For CT imaging, a single phase with portal venous contrast is adequate" — Andrew Trout (guideline) [2:15](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=135) - "MRI has advantages over CT in terms of soft tissue contrast with multiple different sequences, providing the best visualization of both parenchymal and duct changes in chronic pancreatitis" — Andrew Trout (clinical) [2:19](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=139) - "Multiple CT phases including non-contrast, arterial and portal venous phases markedly increase radiation dose in children and do not provide much additional diagnostic information" (clinical) [2:33](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=153) - "Non-contrast CT is essentially never needed in a child with pancreatitis because calcifications can be seen on post-contrast phases" — Andrew Trout (guideline) [2:50](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=170) - "Arterial phase imaging is reserved for specific questions about arterial pseudoaneurysms or when characterizing potential masses" (guideline) [3:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=182) - "Key MRI sequences are 3D MRCP to characterize the duct and its relationship to the bile duct, and T1 weighted sequence to understand parenchymal health" — Andrew Trout (clinical) [3:13](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=193) - "MRI exams can often be performed without IV contrast except for initial characterization when understanding vascular complications or fluid collections" — Andrew Trout (guideline) [3:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=205) - "Cincinnati Children's has an in-house 10 gene pancreatitis risk panel to screen for genetic links to pancreatitis" (clinical) [3:56](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=236) - "It is advised to work closely with a genetic counselor before sending genetic testing to help the family choose the test and interpret it afterwards" — Maisaabel Haija (guideline) [4:06](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=246) - "Genetic testing plays a vital role in early diagnosis and prognosis of pancreatic diseases, potentially guiding new preventative and therapeutic interventions" (opinion) [4:17](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=257) - "Exocrine and endocrine function need assessment because they can decline over time in chronic pancreatitis" — Maisaabel Haija (clinical) [4:32](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=272) - "Problems related to chronic pancreatitis include macro and micronutrient deficiencies, growth problems, small intestinal bacterial overgrowth, and risk for tumors in adulthood" — Maisaabel Haija (clinical) [4:49](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=289) - "Treatment starts with assessing disease stage, finding extent of exocrine or endocrine problems, and correcting nutrient abnormalities and growth issues" — Maisaabel Haija (guideline) [5:18](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=318) - "For pancreatic enzyme replacement, cystic fibrosis guidelines are followed for dosing" (guideline) [5:33](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=333) - "Pancreatic enzyme replacement is reserved only for cases with documented exocrine pancreatic insufficiency" (guideline) [5:39](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=339) - "When medical management fails and the patient continues to have symptoms, endoscopic management is considered" — Maisaabel Haija (guideline) [5:46](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=346) - "Endoscopic therapy relies on two methods: endoscopic ultrasound and endoscopic retrograde cholangiopancreatography (ERCP)" (clinical) [5:55](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=355) - "ERCP is an imaging and interventional modality where the endoscopist can evaluate pancreatic or biliary ducts and treat problems with scarring or strictures" — Maisaabel Haija (clinical) [6:02](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=362) - "Pain management follows a stepwise ladder approach starting with opiate-sparing medications and reserving opiates for severe pain cases" (guideline) [6:22](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=382) - "Opiate-sparing chronic pain medications include neuropathic medications like amitriptyline and gabapentin, usually prescribed in partnership with a pain specialist" (clinical) [6:25](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=385) - "Multidisciplinary pain management includes a pain specialist, psychologist, and physical therapist to address all aspects of pain's impact on the patient's body" — Maisaabel Haija (guideline) [6:47](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=407) - "Psychologists assess pain's functional and emotional impact, as chronic pain can significantly affect daily functioning" (clinical) [6:59](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=419) - "Cognitive behavioral therapy (CBT) is incorporated in pain management at Cincinnati Children's and has been shown in other chronic conditions to be helpful in managing pain" (clinical) [7:10](https://library.globalcastmd.com/watch/chronic-pancreatitis-pancreatic-pathologies-by-cincinnati-children-s-pancreas-care-center-9440?t=430) ## Transcript Global Cat MD along with Cincinnati Children's Hospital sharing knowledge to improve child health around the globe. Welcome back to our educational video series on pancreatic pathologies brought to you by the Pancreas Care Center at Cincinnati Children's. Today's topic is chronic pancreatitis, and we are joined by two experts from our hospital, Doctor Maisaabel Haija, medical director of the Pancreas Care Center, and Doctor Andrew Trout, director of clinical research, Department of Radilogy and Medical imaging. Let's start by learning more on chronic pancreatitis. So, chronic pancreatitis is a chronic inflammatory condition with the inflammation over time, it would result in a damage and destruction of the pancreas as the organ. And that could result in replacement of some of the healthy tissue with fibrosis. The fibrosis is basically a scar tissue that takes over that space in the pancreas, and the ongoing damage in the pancreas affects various types of cells such as Sinor cells, ductal cells, and even islet cells, which are responsible for producing insulin. The function that the Cells could provide would decline when you have chronic pancreatitis. For instance, the asiner cells make digestive enzymes, so if they're diseased or destructed, then you have less of the pancreatic enzymes. When the islet cells which produce insulin are damaged by chronic pancreatitis, it can lead to endocrine issues such as diabetes. Chronic pancreatitis is a progressive. Inflammatory disorder that results in the irreversible loss of pancreatic function. Here's how we diagnose this condition. So diagnosis of chronic pancreatitis is mostly relying on image findings. Diagnosis involves identifying calcifications, ductal obstruction, or dilation combined with one of the following three criteria. Either the pain that is consistent with pancreat. Pic origin or exocrine dysfunction or endocrine dysfunction. When imaging chronic pancreatitis, both MRI and CT can play a role, but what is the best modality for assessing patients with chronic pancreatitis? CT, when it's performed, a single phase with portal venous contrast is adequate. MRI has advantages over CT in terms of the soft tissue contrast that you get with the multiple different MRI sequences, and Going to provide you the best visualization of both parenchymal and duct changes that we see with chronic pancreatitis. What about using IV contrast? When doing CT with IV contrast, often in adults, multiple phases will be acquired, including non-contrast images as well as arterial and portal venous phases. We try to avoid that in children because it markedly increases the radiation dose and it doesn't give us that much additional diagnostic information. And non-contrast CT is essentially never needed in a child with pancreatitis. We can see calcifications on the post-contrast phases of imaging. And in general, we only do portal venous phase imaging. According to Dr. Trout, we reserve arterial face imaging for when there's a specific question about arterial pseudoaneurysms or when we need to characterize potential masses. What about MRI? The key sequences are going to be your MRCP sequence, your 3D MRCP sequence that allows you to. Characterize the duct and its relationship to the bile duct, and then a T1 weighted sequence to understand parenchymal health. At an initial characterization of a patient with a history of acute recurrent or chronic pancreatitis, it can be useful to have contrast there to understand vascular complications or fluid collections. But in many cases we can get away with doing these exams without IV contrast. These imaging tips are important for diagnosis. Now, let's shift our focus. To the role of genetic testing in chronic pancreatitis, there is plenty of genetic testing available that you can order depending on the labs that we send the test to. At Cincinnati Children's, we have an in-house 10 gene pancreatitis risk panel where we screen for the problems with the genetic link and pancreatitis. Of course it is advised before sending genetic testing to work very closely with the genetic counselor so that they can help the family. Choose the test but also interpret it afterwards. Genetic testing plays a vital role in the early diagnosis and prognosis of pancreatic diseases, potentially guiding new and effective preventative and therapeutic interventions. Now, let's discuss the consequences of chronic pancreatitis. We need to keep in mind what could happen from this chronic inflammation, so we assess the exocrine and the endocrine function because those could decline over time. Additionally, we need to maintain a thorough evaluation and workup for complications that may arise as a result of this condition. Some of the other problems that we face when we are dealing with a chronic pancreatitis are related to nutrition, macro and micronutrient deficiencies, growth problems, small intestinal bacterial overgrowth, and in some cases, we also see the risk for tumors, and that's down the line when they are into the adult. There are numerous complications that can arise from chronic pancreatitis. So what are the most effective treatment options? So it starts with assessing the stage of the disease and finding out the extent of the exocrine or the endocrine problems, but also correcting the nutrient abnormalities and nutrition and growth is very important. In terms of pancreatic enzyme replacement, when needed, we follow the cystic fibrosis guidelines for dosing. And we try to reserve them only for the cases that there's a documented exocrine pancreatic insufficiency. In cases where we have tried everything medically and that had failed and the patient continues to have symptoms, we could think next about endoscopic management. And for endoscopic therapy, we rely on two methods, endoscopic ultrasound and endoscopic retrograde cholangio. Cryptography, which is ERCP, and this is an imaging but also interventional modality where the endoscopist could evaluate the pancreatic duct or the biliary ducts and treat any problems with scarring or strictures that is part of the process of chronic pancreatitis. What about pain management? It is a stepwise approach, so we follow. A ladder where we start with opiate sparing medications and reserve opiates for the severe pain cases, and some of the opiate sparing chronic pain medications are neuropathic medications like amitriptyline, gabapentin, and usually those are in partnership with a pain specialist prescribing the medications and part of the multidisciplinary management. Of pain is having a pain specialist and a psychologist and a physical therapist so that we can make progress and address all the aspects that the pain could take on a patient's body. Psychologists play a key role in helping patients cope with pain by assessing its functional and emotional impact, as chronic pain can significantly affect daily functioning. But what we know and we incorporate in our management here at Cincinnati Children's is a multidisciplinary pain management, and in those cases we apply cognitive behavioral therapy or CBT that has been shown in other chronic conditions to be very helpful in managing the pain. Let's summarize what we learned today. Chronic pancreatitis is a progressive inflammatory condition that leads to the irreversible destruction of pancreatic tissue. Affecting both exocrine and endocrine functions, potentially resulting in nutrient deficiencies and diabetes, diagnosis relies on imaging techniques such as MRI and CT to detect calcifications, ductal obstruction, or dilation. Genetic testing plays a critical role in early diagnosis and guiding treatment strategies. Treatment includes managing. nutritional deficiencies, pancreatic enzyme replacement, endoscopic interventions, and a stepwise pain management approach involving a multidisciplinary team of pain specialists, psychologists, and physical therapists to address both the physical and emotional aspects of chronic pain. Thank you for watching this video. For a detailed look at the surgical management of chronic pancreatitis and a complete walkthrough of a TPIT procedure, stay tuned for our surgical video featuring Doctor Juan Gua from Cincinnati Children's. Link in the description below. --- Not medical advice · citation policy: https://library.globalcastmd.com/ai