Chronic Pancreatitis: Causes, Diagnosis and Treatment
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Chronic Pancreatitis: Causes, Diagnosis and Treatment

The causes of chronic pancreatitis include alcohol, malnutrition (tropical pancreatitis), and genetic causes (hereditary pancreatitis and cystic fibrosis). Approximately 20% of cases of chronic pancreatitis have no obvious etiology.

Chronic pancreatitis is a persistent inflammatory disease of the pancreas associated with morphologic or functional damage to the pancreas.

The causes of chronic pancreatitis include alcohol, malnutrition (tropical pancreatitis), and genetic causes (hereditary pancreatitis and cystic fibrosis). Approximately 20% of cases of chronic pancreatitis have no obvious etiology.

Clinical features of chronic pancreatitis include abdominal pain, weight loss, malabsorption, and diabetes mellitus. Weight loss is complex, however in part, since eating certain foods may exacerbate the pain, and patients avoid eating. Malabsorption caused by pancreatic exocrine insufficiency can also contribute to weight loss. Pancreatic endocrine insufficiency is caused by loss of pancreatic islet cells and results in glucose intolerance.

The diagnosis of chronic pancreatitis can be established with functional or structural studies. Functional studies assess pancreatic exocrine function by testing for the presence of malabsorption. Classically, this involves quantitation of fat in a 72-hour stool collection while on a 100g fat diet (>7 g/day of fat is considered abnormal). A random test for fecal fat is a simple screening procedure as is a test for the presence of fecal elastase (sensitivity and specificity of 95%). Serum concentrations of amylase and lipase are often normal in patients with chronic pancreatitis because of the patchy nature of the injury. Structural studies (CT or ERCP) are aimed at demonstrating either the characteristic pancreatic calcification of chronic pancreatitis or dilatation of the pancreatic duct.

The management of chronic pancreatitis is typically focused on control of pain, which can be chronic and severe. It is important to eliminate precipitating factors such as alcohol and a high-fat diet. If simple analgesics are not effective or if significant fat malabsorption exists, administration of pancreatic enzyme supplements should be offered. Pancreatic enzymes require an alkaline environment to promote activation and, therefore, are usually given with an acid suppressant in the form of an H2-blocker or a proton pump inhibitor.

Celiac plexus block by injection of alcohol or steroids has had limited success in relieving pancreatic pain and should be considered experimental.

Pain that persists despite the use of narcotic analgesics merits evaluation with an ERCP for the presence of a pancreatic duct stricture (which can be dilated or even stented) or stones in the pancreatic duct, which can be removed.

Surgery is reserved for severe and refractory cases. Pancreaticojejunostomy has been used to drain a dilated pancreatic duct although a pancreatic resection is occasionally performed in an attempt to relieve severe pain.

Pancreatic exocrine insufficiency is treated with purified extracts of pancreas containing active pancreatic enzymes. The extract is sprinkled over food.

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Comments (1)

Thank you for this valuable information.

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