Management of pancreatitis

This is a new guideline from NICE on pancreatitis from Sep 2018. Most of it is aimed at secondary care, but there are a few things that are useful for us which I've outlined below.

Advice to give patients

  • Recovery can take up to 3 x as long as the hospital stay (which can itself be months).
  • Warn patients that alcohol can aggravate even non-alcohol related pancreatitis.
  • There is a link between smoking and chronic pancreatitis.
  • Consider the need for psychological support. Pancreatitis can have a big impact on quality of life.

GP follow up

  • Patients need an HbA1c every 6m (there is an 80% lifetime risk of diabetes after chronic pancreatitis).
  • Patients need a DEXA scan every 2 yrs.

Chronic pancreatitis

  • Beware of this as a cause of chronic or recurrent upper abdominal pain.
  • Patients have a high risk of malnutrition and malabsorption. Specialist centres should be monitoring regularly for this (every 12m in adults and every 6m in young people).
  • Neuropathic pain may be associated and should be treated in the same way that other neuropathic pain should. NICE has separate guidance on this.
  • Diabetes associated with chronic pancreatitis is termed Type 3c diabetes. The need for insulin should be assessed every 6m. It should be managed in the same way that other diabetes should be managed.
  • There is a higher risk of cancer in patients with hereditary pancreatitis; there is a 40% lifetime risk of pancreatic cancer.

 

I’m a freelance GP locum in Winchester & Southampton.

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