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Chronic pancreatitis: Difference between revisions
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(Created page with "Chronic pancreatitis is characterised by chronic inflammation of the pancreas with replacement of normal parenchyme by fibrotic scar tissue, which causes chronic abdominal pain and pancreatic insufficiency. It is an ongoing, progressive pathologic response to pancreatic injury. In most cases, chronic pancreatitis is caused by relapsing episodes of acute pancreatitis. The disease progresses gradually from a single episode of acute appendicitis to relapsing episodes of acu...") |
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Chronic pancreatitis is characterised by chronic inflammation of the pancreas with replacement of normal parenchyme by fibrotic scar tissue, which causes chronic abdominal pain and pancreatic insufficiency. It is an ongoing, progressive pathologic response to pancreatic injury. In most cases, chronic pancreatitis is caused by relapsing episodes of acute pancreatitis. The disease progresses gradually from a single episode of acute appendicitis to relapsing episodes of acute appendicitis to chronic appendicitis. | '''Chronic pancreatitis''' is characterised by chronic inflammation of the pancreas with replacement of normal parenchyme by fibrotic scar tissue, which causes chronic abdominal pain and pancreatic insufficiency. It is an ongoing, progressive pathologic response to pancreatic injury. In most cases, chronic pancreatitis is caused by relapsing episodes of [[acute pancreatitis]]. The disease progresses gradually from a single episode of acute appendicitis to relapsing episodes of acute appendicitis to chronic appendicitis. | ||
== Etiology == | == Etiology == | ||
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* Toxic-metabolic factors | * Toxic-metabolic factors | ||
** Alcohol abuse | ** [[Alcohol]] abuse | ||
** Tobacco smoking | ** Tobacco [[smoking]] | ||
** Hypertriglyceridaemia | ** [[Hypertriglyceridaemia]] | ||
* Idiopathic | * Idiopathic | ||
* Genetic (hereditary pancreatitis, cystic fibrosis) | * Genetic (hereditary pancreatitis, [[cystic fibrosis]]) | ||
* Autoimmune | * Autoimmune | ||
* Recurring acute pancreatitis | * Recurring acute pancreatitis | ||
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== Clinical features == | == Clinical features == | ||
Abdominal pain in the epigastric region which radiates to the back and nausea/vomiting are the most common symptoms. | Abdominal pain in the epigastric region which radiates to the back and nausea/vomiting are the most common symptoms. | ||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Contrast CT or | Contrast [[CT]] or [[MRCP]] will show pancreatic atrophy and parenchymal calcification. If other investigations are not diagnostic, pancreatic functional diagnostics may be used. | ||
The most likely underlying cause of the chronic pancreatitis must be sought, based on history of exposure to risk factors, lab tests, and possibly genetic testing. | The most likely underlying cause of the chronic pancreatitis must be sought, based on history of exposure to risk factors, lab tests, and possibly genetic testing. | ||
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Treatment for chronic pancreatitis unfortunately is not curative. Patients should avoid risk factors like smoking and alcohol, and they should consume low-fat, small meals. Painkillers are often necessary for chronic abdominal pain. | Treatment for chronic pancreatitis unfortunately is not curative. Patients should avoid risk factors like smoking and alcohol, and they should consume low-fat, small meals. Painkillers are often necessary for chronic abdominal pain. | ||
Coeliac ganglion block is an option for refractory pain. A permanent coeliac ganglion block (coeliac plexus neurolysis) can be used for pain management in case pharmacological therapy is insufficient. This involves radiographically guided puncture of the coeliac ganglion, followed by installation of ethanol, which destroys the nerve tissue permanently. Injection of a local anaesthetic instead produces temporary pain relief | [[Coeliac ganglion block]] is an option for refractory pain. A permanent coeliac ganglion block (coeliac plexus neurolysis) can be used for pain management in case pharmacological therapy is insufficient. This involves radiographically guided puncture of the coeliac ganglion, followed by installation of ethanol, which destroys the nerve tissue permanently. Injection of a local anaesthetic instead produces temporary pain relief | ||
Patients with diagnosed exocrine pancreatic insufficiency require pancreatic enzyme supplementation, which is to be taken with foods. | Patients with diagnosed exocrine pancreatic insufficiency require pancreatic enzyme supplementation, which is to be taken with foods. | ||
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== Complications == | == Complications == | ||
Complications of loss of pancreatic function can cause [[pancreoprivic diabetes mellitus]], maldigestion and [[Malabsorption syndromes|malabsorption]], [[osteoporosis]], and steatorrhoea. | |||
[[Category:Gastroenterology]] | [[Category:Gastroenterology]] | ||
[[Category:Gastrointestinal surgery]] | [[Category:Gastrointestinal surgery]] | ||