Pancreatitis: Chronic

• What is Pancreatitis (Chronic)
• Statistics on Pancreatitis (Chronic)
• Risk Factors for Pancreatitis (Chronic)
• Progression of Pancreatitis (Chronic)
• Symptoms of Pancreatitis (Chronic)
• Clinical Examination of Pancreatitis (Chronic)
• How is Pancreatitis (Chronic) Diagnosed?
• Prognosis of Pancreatitis (Chronic)
• How is Pancreatitis (Chronic) Treated?
• Pancreatitis (Chronic) References

What is Pancreatitis (Chronic)

Chronic pancreatitis is a chronic inflammatory process of the pancreas. It is a similar, but more low-grade, ongoing process than acute pancreatitis, characterised by recurrent symptoms of abdominal pain, with progressive damage to the pancreas which in the end often results in pancreatic insufficiency.

The pancreas is important for the digestion of nutrients in the gut (by secreting digestive enzymes into the duedenum), as well as for regulation of blood glucose (by secreting regulatory hormones such as insulin and glucagon). Hence, the end result of the process may be malabsorption of nutrients and/or diabetes mellitus.

Statistics on Pancreatitis (Chronic)

This condition is not nearly as common as acute pancreatitis. Its incidence is around 4 per 100,000 overall, with a male to female ratio of three to one. Among alcoholics the prevalence is much higher.

Risk Factors for Pancreatitis (Chronic)

The most important causative factors are:

• Chronic alcohol abuse: by far the most common cause;
• Hereditary (familial): genetic causes. Often starts in childhood, and there is a family history in relatives;
• Nutritional (or “tropical”): occurs in young adults in developing countries – believed to be due to deficiencies in the diet – mainly protein and fat;
• Distal pancreatitis: believed to be due to formation of a blockage in the pancreatic duct after trauma (eg motor vehicle accident)

Progression of Pancreatitis (Chronic)

There are exacerbations and remissions ultimately leading to chronic abdominal pain which can progress to malabsorption and diabetes. Pseudocysts (fluid filled cavities due to inflammation lined by scar tissue) form frequently – and these may require surgery or less invasive needle aspiration to be removed.

If alcohol abuse is the cause – if the patient can abstain from alcohol there is some evidence that the severity and frequency of the painful episodes will decrease.

How is Pancreatitis (Chronic) Diagnosed?

• Amylase/Lipase: may be elevated in acute exacerbations;
• Liver function tests – may be signs of bile duct obstruction;
• Blood glucose level – may be elevated in diabetes;
• Plain abdominal x-ray– may show calcification in the region of the pancreas.

Prognosis of Pancreatitis (Chronic)

Chronic pancreatitis is mostly a disabling condition rather than a life-threatening one. With progressive gland destruction there will be malabsorption of nutrients and also diabetes – but these can be managed with dietary/enzyme supplements and insulin respectively.

There is a modest risk of pancreatic cancer, probably associated with alcohol abuse and cigarette smoking, rather than the chronic pancreatitie per se. Prognosis is similar for other causes of chronic pancreatitis.

How is Pancreatitis (Chronic) Treated?

• Stop alcohol completely
• Long acting analgesics, often opiates or coeliac plexus block may be helpful.
• Diet – appropriate carbohydrates. Low fat and protein in an easily absorbable form.
• Pancreatic supplements may be needed for malabsorption.
• Insulin- may be required if diabetes present. Surgery may be required for any complications.

Pancreatitis (Chronic) References

1. Braunwald, Fauci, Kasper, Hauser, Longo, Jameson. Harrison’s Principles of Internal Medicine. 15th Edition. McGraw-Hill. 2001
2. Cotran, Kumar, Collins 6th edition. Robbins Pathologic Basis of Disease. WB Saunders Company. 1999.
3. Haslet C, Chiliers ER, Boon NA, Colledge NR. Principles and Practice of Medicine. Churchill Livingstone 2002.
4. Hurst JW (Editor-in-chief). Medicine for the practicing physician. 4th edition Appleton and Lange 1996.
5. Kumar P, Clark M. CLINICAL MEDICINE. WB Saunders 2002
6. Longmore M, Wilkinson I, Torok E. OXFORD HANDBOOK OF CLINICAL MEDICINE. Oxford Universtiy Press. 2001
7. McLatchie G and LEaper DJ (editors). Oxford Handbook of Clinical Surgery 2nd Edition. Oxford University Press 2002.
8. MEDLINE Plus
9. Raftery AT Churchill’s pocketbook of Surgery. Churchill Livingsone 2001.
10. Tjandra, JJ, Clunie GJ, Thomas, RJS,; Textbook of Surgery, 2nd Ed, Blackwell Science, Asia. 2001.