Chronic Pancreatitis

Introduction

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve—it gets worse over time and leads to permanent damage. Chronic pancreatitis eventually impairs a patient’s ability to digest food and make pancreatic hormones due to permanent scarring and damage to the pancreas. Calcium stones and cysts may develop in the pancreas, which can block the duct, or tube, that carries digestive enzymes and juices. The blockage may lower the levels of pancreatic enzymes and hormones, which will make it harder for the body to digest food and regulate blood sugar. This can cause serious health problems, including malnutrition and diabetes.

Causes

Alcohol is the commonest cause of chronic pancreatitis in India.

Other causes are:

  • Heredity (genetic mutations)
  • Autoimmune problems
  • Blockages of common bile duct or pancreatic duct
  • Cystic fibrosis
  • Hyperparathyroidism
  • Hypertriglyceridemia: high levels of triglycerides
  • Certain medications such as azathioprine, thiazides, sulfonamides etc.
  • Smoking
Symptoms
  • Pain in your upper abdomen
  • Diarrhea
  • Fatty stools, which are loose, pale, and don’t flush away easily
  • Nausea and vomiting
  • Unexplained weight loss
  • Diabetes mellitus
  • Fatty and oily stools

Painful episodes can last for hours or even days. Some people find that eating or drinking can make their pain worse. As the disease progresses, the pain may become constant.

Diagnosis Tests
  • Fecal fat test measures the fat in stool and absorption rates of the body.
  • Serum amylase measures the level of enzymes in the blood.
  • Serum IgG4 is done to diagnose autoimmune pancreatitis.
  • Serum lipase measures the level of lipase in the blood.
  • Serum trypsinogen is done to measure trypsinogen levels in the blood.
  • Abdominal CT scan produces cross-sectional pictures of the abdomen.
  • Abdominal ultrasound examines in the internal organs such as the spleen, pancreas and kidneys located in the belly.
  • ERCP is a combination of fluoroscopy and endoscopy done to diagnose problems in the upper GI tract non-invasively.
  • EUS combining endoscopy and ultrasound, helps obtain high quality imagery using an endoscope.
  • MRCP scan is a non-invasive technique of visualizing pancreatic and biliary ducts.
Treatments

Treatment for chronic pancreatitis focuses on reducing pain and improving digestive function. The damage to pancreas can’t be undone, but with the proper care, the symptoms can be managed well. Treatment for pancreatitis can include medication, endoscopic therapies, or surgery.

SURGERY FOR CHRONIC PANCREATITIS

Surgery is the primary treatment and helps relieving pain by decompressing the pancreatic duct. Sometimes a reasonable amount of pancreatic parenchyma is cored out to alleviate pain originating from the head of the pancreas. If there is severe pain that isn’t responding to medication, removing part of the pancreas can provide relief. Surgery may also be used to unblock the pancreatic duct, drain cysts, or to widen the duct if it’s too narrow. Avoidance of alcohol is mandatory, even if alcohol wasn’t the cause of pancreatitis. Avoid smoking because it can increase your risk of developing pancreatic cancer.