-Chronic pancreatitis is a syndrome involving inflammation, fibrosis, and loss of acinar and islet cells in the pancreas.
-Causes: Alcoholism (70%), smoking, duct obstruction, hyperparathyroidism, cystic fibrosis, hyperlipidemia
-the most common cause of clinically apparent chronic pancreatitis in adults is alcoholism; in children is cystic fibrosis
-Smoking is an independent, dose-dependent risk factor for chronic pancreatitis
Symptoms & Signs
Abdominal pain: epigastric, often radiating to the back, may be relieved by sitting upright or leaning forward, often worse 15 to 30 minutes after eating; nausea, vomiting, fat malabsorption (poorly formed greasy, malodorous stools); Diabetes
Diagnosis relies on a combination of clinical findings, laboratory findingsimaging tests, and pancreatic function testing.
Labs: Secretin pancreatic function test
Amylase and lipase: elevated in the early disease; normal or low in later stages. Thus, unlike in acute pancreatitis, they are neither diagnostic nor prognostic in chronic pancreatitis
Fecal Pancreatic Elastase-1 (FPE-1): A level >200 μg/g of stool is considered normal, and FPE-1 levels <100 μg/g of stool correlate with severe exocrine pancreatic insufficiency.
Imaging: Transabdominal ultrasound, Contrast-enhanced CT and MRI
The diagnosis is confirmed if there are calcifications within the pancreas on CT Scan.
Pancreatogram: beading of the pancreatic ducts
Steatorrhea: A 72-hour quantitative fecal fat determination is the gold standard.
Life style modifications: Cessation of alcohol and of smoking;
Pain control: Analgesics
Supplements: Pancreatic enzymes, lipase, vitamins
Ductal stone obstruction: Endoscopic clearance, surgical therapy, ESWL
Check for IBS: Pancreatic exocrine insufficiency is also seen in Diarrhea-predominant irritable bowel syndrome (D-IBS). So, check for PEI in D-IBS.
Complications: Pseudocyst, biliary ductal obstruction, fistula, pseudoaneurysms, pancreatic cancer