Chronic pancreatitis

Definition

Chronic pancreatitis is ongoing inflammation of the pancreas. The pancreas is an organ located behind the stomach that produces chemicals needed to digest food, as well as the hormones insulin and glucagon.

Causes

Chronic pancreatitis causes inflammation and scarring of tissue in the pancreas. This makes the pancreas unable to produce the right amount of chemicals (enzymes) needed to digest fat. It also interferes with insulin production, which may lead to diabetes.

Persons with chronic pancreatitis have attacks of abdominal pain and digestive problems. The symptoms may become more frequent as the condition gets worse. The symptoms may mimic pancreatic cancer.

The condition is most often caused by alcoholism and alcohol abuse, but sometimes the cause cannot be determined. Genetic causes are become more common. Conditions such as hyperlipidemia or hyperparathyroidism, injury, and chronic blockage of the pancreatic duct are also linked to chronic pancreatitis.

Chronic pancreatitis occurs more frequently in men than in women, perhaps because alcohol-use disorders are more common in men.

Symptoms

• Abdominal pain
  • Greatest in the upper abdomen
  • May last from hours to days
  • Eventually may be continuous
  • May be worsened by eating or drinking
  • May be worsened by alcohol consumption
  • May radiate to the back
• Nausea and vomiting
• Unintentional weight loss
• Fatty stools

Sitting up and leaning forward may sometimes relieve the abdominal pain associated with pancreatitis.

Pale or clay-colored stools may also be associated with this condition.

Exams and Tests

• Serum lipase may be higher than normal, but can return to normal as the disease gets worse.
• Serum amylase may be higher than normal, but can return to normal as the disease gets worse.
• Serum trypsinogen may be low.
• Fecal fat test shows fatty stools.

Inflammation or calcium deposits of the pancreas may be evident on:

• Abdominal CT scan
• Abdominal ultrasound
• ERCP

An exploratory laparotomy may be done to confirm the diagnosis of pancreatitis.

Treatment

The goal of treatment is to reduce stimulation of the pancreas, prevent indigestion, reduce pain, and treat diabetes (if present). Treatment may involve:

• Eating a low-fat diet
• Getting enough fat-soluble vitamins and calcium in the diet
• Analgesics or surgical nerve block to relieve pain
• Insulin to control blood sugar levels
• Supplemental pancreatic enzymes to correct underproduction

Patients must not drink alcohol.

Surgery may be recommended if a blockage is found. In severe cases, part or all of the pancreas may be removed.

Outlook (Prognosis)

This is a serious disease that may lead to disability and death. The risk of death may be lowered the person continues to avoid alcohol.

Possible Complications

• Obstruction of the small intestine or bile ducts
• Pancreatic insufficiency
  • Diabetes
  • Fat malabsorption
• Ascites
• Pancreatic pseudocysts (fluid collections), which may become infected
• Blood clots in the splenic vein

When to Contact a Medical Professional

Call for an appointment with your health care provider if you develop symptoms of pancreatitis.

Call for an appointment with your provider if you have pancreatitis and your symptoms worsen or do not improve with treatment.

Prevention

Determining the cause of acute pancreatitis and treating it promptly may help to prevent chronic pancreatitis. Avoiding heavy consumption of alcohol dramatically reduces the risk of developing this condition.

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