Chronic pancreatitis
From Wikipedia, the free encyclopedia
| Chronic pancreatitis Classification and external resources |
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| ICD-10 | K86.0-K86.1 |
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| ICD-9 | 577.1 |
Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption.
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[edit] Symptoms
Patients with chronic pancreatitis can present with persistent abdominal pain or steatorrhea (diarrhea resulting from malabsorption of the fats in food, typically very bad-smelling and equally hard on the patient), as well as severe nausea. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all. Many of these patients suffer from polyfecalia.
Considerable weight loss, due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein.
[edit] Causes
About 70% of adult cases are caused by chronic alcohol use, and most patients have consumed more than 150 g/day of alcohol over six to twelve years.[1] Gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and some cases of chronic pancreatitis are of undetermined or idiopathic origin. A few are inherited or autoimmune in nature or secondary to Sphincter of Oddi Dysfunction (SOD). Other less frequent causes include chronic steroid and or anti-inflammatory use. In up to one quarter of cases, no cause can be found.[citation needed]
Cystic fibrosis is the most common cause of chronic pancreatitis in children. In other parts of the world, severe protein-energy malnutrition is a common cause.[citation needed]
[edit] Diagnosis
Serum amylase and lipase may well not be elevated in cases of advanced chronic pancreatitis, but are often used as markers for detecting pancreatic inflammation in undiagnosed patients. Common tests used to determine chronic pancreatitis are serum amylase and serum lipase blood tests, triglyceride blood tests, enzyme measurement in stool, X-rays, ultrasounds, EUS, CT scans, MRI's and MRCP's. A more invasive test called an ERCP (endoscopic retrograde cholangiopancreatography), is considered the gold standard procedure for diagnosing chronic pancreatitis. Pancreatic calcification can often be seen on X-rays, as well as CT scans.
There are other laboratory studies useful in diagnosis of chronic pancreatitis. Serum biliruin and alkaline phosphatase can be elevated, indicating possible compression of the intrapancreatic bile duct due to either edema, fibrosis, or cancer. When the chronic pancreatitis is due to an autoimmune process, elevations in ESR, IgG4, rheumatoid factor, ANA, and antismooth muscle antibody may be seen. The common symptom of chronic pancreatits, steatorrhea, can be diagnosed by two different studies; Sudan staining of feces or fecal fat excretion over 24hr on a 100g fat diet. To check for pancreatic exocrine dysfunction, the most sensitive and specific test is the measurement of fecal elastase, which can be done with a single stool sample and a value of less than 200 ug/g indicates pancreatic insufficiency.[2]
[edit] Treatment
The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.[3] Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Diabetes may occur and need long term insulin therapy. (Type 3 diabetes)
The abdominal pain can be very severe and require high doses of analgesics. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.
[edit] Pancreatic Enzyme Supplementation
Replacement pancreatic enzymes are often effective in treating the malabsorption and steatorrhea. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.[4]
While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis. Patients with alcoholic pancreatitis may be less likely to respond. [5]
[edit] Surgery
Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.[6]
[edit] References
- ^ Nair RJ, Lawler L, Miller MR (2007). "Chronic pancreatitis". Am Fam Physician 76 (11): 1679–88. PMID 18092710.
- ^ Template:Uptodate, Clinical manifestations and diagnosis of chronic pancreatitis in adults, Author Steven D. Freedman, MD, PhD
- ^ American Gastroenterological Association Medical Position Statement (1998). "American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis". Gastroenterology 115 (3): 763-4. PMID 9721174.
- ^ Warshaw AL, Banks PA, Fernández-Del Castillo C (1998). "AGA technical review: treatment of pain in chronic pancreatitis". Gastroenterology 115 (3): 765-76. doi:. PMID 9721175.
- ^ Template:Uptodate, Treatment of Chronic Pancreatitis, Author Steven D. Freedman, MD, PhD
- ^ Society for Surgery of the Alimentary Tract (SSAT) (2004). Operative treatment for chronic pancreatitis.. Retrieved on 2007-06-09.
[edit] See also
[edit] External links
- VIDEO - Chronic Pancreatitis: Recent Advances and Ongoing Challenges, Jeffery B. Matthews, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
