Chronic Pancreatitis

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Overview

The pancreas is an accessory organ of digestion known to have dual functions in the endocrine and exocrine systems. It is necessary for the hydrolysis of macromolecules including proteins, carbohydrates, and fats (in combination with bile from the common bile duct). The pancreas has a main pancreatic duct running through the length of it, an accessory duct, and many various cell types. The ducts can become blocked, or they can be genetically deformed. During constant inflammation, scarring and fibrosis of the ducts lead to permanent damage to many structures, impairing its secretory functions.


Chronic pancreatitis is a progressive inflammatory disease of the pancreas that affects both functions of the pancreas. For example, when the exocrine function is affected, patients will present with pancreatic insufficiency, steatorrhea, and weight loss. Pancreatic insufficiency results when greater than 90% of the organ is damaged. The incidence depends on the severity of disease and can be as high as 85% in severe chronic pancreatitis. On the other hand, impairment of the endocrine function of the pancreas will eventually result in pancreatogenic diabetes (Type 3c diabetes).


Chronic pancreatitis is unlike acute pancreatitis. The latter presents with acute onset abdominal pain radiating to the back. Patients with chronic pancreatitis may be asymptomatic for long periods of time. At other times, they may also have unrelenting abdominal pain with breakthrough pain requiring hospitalization. This disease process varies from acute pancreatitis in another way, in other words, histologically. The types of inflammatory cells present are different. Acute pancreatitis has a predominance of neutrophils, while chronic pancreatitis has more mononuclear infiltrates.

Symptoms

Pain in the upper belly that spreads into the back.

Pain in the belly that gets worse when you eat or drink alcohol.

Diarrhea or oily stools.

Nausea and vomiting.

Severe belly (abdominal) pain that may be constant or that comes back.

Weight loss

Causes

An attack of acute pancreatitis that damages your pancreatic ducts.

A blockage of the main pancreatic duct caused by cancer.

Certain autoimmune disorders.

Cystic fibrosis.

Hereditary diseases of the pancreas.

Smoking.

Unknown cause in some cases.

Risk factors

The cumulative risk for recurrent pancreatitis over 5 years was highest among smokers at 40% (compared with 13% for nonsmokers). For alcohol abusers and current smokers, the cumulative risks for CP were similar-approximately 18%.

Excessive alcohol consumption. Research shows that heavy alcohol users (people who consume four to five drinks a day) are at increased risk of pancreatitis.

Cigarette smoking. ...

Obesity. ...

Diabetes. ...

Family history of pancreatitis.

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Complications

Chronic pancreatitis has many complications including:


Formation of a pseudocyst, which can obstruct the bile duct

Recurrent acute pancreatitis, especially in alcoholics who continue to drink

Splenic venous thrombosis

Pancreatic ascites or pleural effusion (rare)

Pseudoaneurysms (rarely of the vessels close to the pancreas)

Pancreatic diabetes (later in disease course)

Of note, patients with chronic pancreatitis are at increased risk of developing pancreatic cancer.

Prevention

The best way to prevent chronic pancreatitis is to drink only in moderation or not at all. Moderate alcohol drinking is considered to be no more than 1 drink per day for women and 2 drinks per day for men. Quitting smoking is also very helpful.

Stop drinking alcohol. Even if alcohol was not deemed to be the cause of acute pancreatitis, it is prudent to stop drinking alcohol while recovering. ...

Stop smoking. If you smoke, quit. ...

Choose a low-fat diet. ...

Drink more fluid