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慢性胰腺炎背景的糖尿病性肌肉坏死
Nambi Nallasamy, HMS III
Our Patient
Imaging Chronic Pancreatitis
Lab Findings
Imaging Acute Pancreatitis
Imaging of Our Patient
Putting it all Together
Bob is a 39 yo M with a h/o:
chronic pancreatitis s/p distal pancreatectomy
splenectomy
pancreatic pseudocyst
past EtOH abuse
HTN, DM, and hypercholesterolemia
He presented to the ED with:
new back pain, confusion, fatigue, weakness, abd
discomfort, and fever
Extensive past EtOH use (started drinking in 7th
grade, 30 beers/night in his 20s)
Has been abstinent since 2001 per his record
Alcoholic pancreatitis, s/p distal pancreatectomy
10 yrs ago
ARDS with hx tracheostomy
Splenic hematoma splenectomy
Chronic abd pain since splenectomy, on methadone
and oxycodone
Portal vein thrombosis with partial occlusion
Asthma
Depression
Our Patient
Imaging Chronic Pancreatitis
Lab Findings
Imaging Acute Pancreatitis
Imaging of Our Patient
Putting it all Together
Alcohol abuse
Cigarette smoking
Hereditary Pancreatitis (AD, 80%
penetrance)
Onset before 20, often before 5
Ductal obstruction
Strictures 2/2 trauma, pseudocysts, calcific
stones, or tumors
Tropical pancreatitis (possible SPINK1
mutation relation)
CF gene mutation
Chronic inflammation of the pancreas leads to:
Destruction of pancreatic acini fibrosis
Pancreatic duct dilation and irregularity 2/2 formation
of intraductal protein plugs and calcifications
▪ Protein plugs serve as nidus for calcification within inter‐and
intra‐lobular ducts
▪ Ductal epithelial lesions result scarring and obstruction of
ducts inflammatory changes and cell loss
▪ Protein plugs consist primarily of GP2, a glycosyl
phsphatidylinositol anchored protein that is cleaved from the
zymogen granule membrane and secreted into pancr
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