Chronic Pancreatitis

27th November 2006 at 11:21 GMT by Dr.C.A.Jenner MB BS, FRCA. Permalink.

Article on the clinical features and treatment of Chronic Pancreatitis

Introduction

Chronic pancreatitis is a medical condition in which the pancreas is persistently inflamed over a long period.

The pancreas is a soft, elongated gland situated at the back of the upper abdominal cavity, behind the stomach. This organ produces chemicals needed to digest food (digestive enzymes), along with the hormone insulin and glucagon.

Key Symptoms

The abdominal pain in chronic pancreatitis has its own set of typical symptoms. Here we list a few main characteristics of abdominal pain in this condition:

• Greatest in the upper abdomen
• May last from hours to days
• Eventually may be continuous
• May worsen with eating or drinking
• May worsen with alcohol consumption
• May radiate to the back

Other symptoms of chronic pancreatitis include:

• Diabetes
• Nausea and vomiting
• Vomiting after meals
• Poor pancreatic function
• Unintentional weight loss
• Fatty stools
• Pale or clay-colored stools

Causative Factors

Long-term excessive alcohol consumption is the most common cause of chronic pancreatitis. In fact, the risk of developing chronic pancreatitis is directly associated to the amount of alcohol consumed.

Other main causes of chronic pancreatitis include:

• High levels of calcium in the blood
• Abnormalities in anatomy present at birth
• Blocked or narrowed pancreatic duct due to trauma or pseudocysts
• Systemic disease, such as cystic fibrosis
• Heredity
• High blood fats or Hypertriglyceridaemia
• Side effects of drugs
• No specific cause known (idiopathic pancreatitis)

Diagnostic Tools

A series of tests are carried out to confirm the presence of chronic pancreatitis. Here we briefly list each one of them:

1. Blood Tests: These can confirm the presence of digestive enzymes that have leaked out of the pancreas into the bloodstream when the pancreas in inflamed. The two most common tests are the serum amylase test and the serum lipase test.
2. Stool test: These tests detect steatorrhea, which are the abnormal levels of fat in a stool sample.
3. Imaging tests: These provide information regarding the structure of pancreas, the ducts that drain the pancreas and gallbladder and the surrounding tissues. The main tests are:

• X-rays
• Ultrasound
• CT scans
• MRI scans
• Endoscopic retrograde cholangiopancreatography (ERCP)
• Endoscopic ultrasound
• Magnetic resonance cholangiopancreatography (MRCP)

4. Pancreatic function tests

• Secretion stimulation test
• Bentiromide test

Tests for pancreatic cancer are also carried out in this health condition.

Treatment Options

Treatment of chronic pancreatitis is aimed at relieving pain accompanied with more severe measures in the later stages of treatment. The main treatment options include:

• Avoiding alcohol
• Modifying meals
• Narcotic analgesics
• Non-narcotic analgesics
• Insulin to control blood sugar levels
• Pancreatic enzyme supplements
• Injections for nerve block
• Treatments to widen pancreatic ducts
• Pancreatic lithotripsy
• Surgical procedures