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Chronic pancreatitis: Difference between revisions
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<section begin="radiology" />'''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 having multiple episodes of [[acute pancreatitis]]. The disease progresses gradually from a single episode of acute pancreatitis to relapsing episodes of acute pancreatitis to chronic pancreatitis.<section end="radiology" /> | <section begin="clinical biochemistry" /><section begin="radiology" />'''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 having multiple episodes of [[acute pancreatitis]]. The disease progresses gradually from a single episode of acute pancreatitis to relapsing episodes of acute pancreatitis to chronic pancreatitis.<section end="radiology" /><section end="clinical biochemistry" /> | ||
== Etiology == | == Etiology == | ||
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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. | ||
<section begin="radiology" /> | <section begin="clinical biochemistry" /><section begin="radiology" /> | ||
== Diagnosis and evaluation == | == Diagnosis and evaluation == | ||
Contrast [[CT]] or [[MRCP]] will show pancreatic atrophy and parenchymal calcification. If other investigations are not diagnostic, pancreatic functional diagnostics may be used. | Contrast [[CT]] or [[MRCP]] will show pancreatic atrophy and parenchymal calcification. If other investigations are not diagnostic, pancreatic functional diagnostics may be used.<section end="radiology" /> 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. Unlike in acute pancreatitis, amylase and lipase are rarely elevated. | ||
<section end="radiology" /> | |||
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. | |||
=== Functional diagnostics of pancreatic insufficiency === | === Functional diagnostics of pancreatic insufficiency === | ||
==== Direct pancreatic functional testing ==== | ==== Direct pancreatic functional testing ==== | ||
IV administration of pancreas-stimulating hormones (secretin or cholecystokinin) stimulates the secretion of pancreatic juice. This fluid can be collected by an oroduodenal tube or an upper endoscope and measured. A bicarbonate concentration of this fluid of < 80 mEq/L is diagnostic of exocrine pancreatic insufficiency. | IV administration of pancreas-stimulating hormones (secretin or cholecystokinin) stimulates the secretion of pancreatic juice. This fluid can be collected by an oroduodenal tube or an upper endoscope and measured. A bicarbonate concentration of this fluid of < 80 mEq/L is diagnostic of exocrine pancreatic insufficiency. | ||
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==== Indirect pancreatic functional testing ==== | ==== Indirect pancreatic functional testing ==== | ||
Measuring the amount of elastase in the stool can be used for diagnosis of exocrine pancreatic insufficiency. | Measuring the amount of elastase in the stool can be used for diagnosis of exocrine pancreatic insufficiency. Impaired glucose tolerance or diabetes mellitus may be due to endocrine pancreatic insufficiency. Increased content of lipids in the stool may indicate lipase deficiency due to pancreatic insufficiency.<section end="clinical biochemistry" /> | ||
== Treatment == | == Treatment == | ||