Chronic pancreatitis

Information about Chronic pancreatitis

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.

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.

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.

Causes

The most common cause in the Western world of chronic pancreatitis is excess alcohol ingestion. 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-inflammitory use. In up to one quarter of cases, no cause can be found.

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.

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.

Treatment

The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.[1] 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.

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.[2]

Surgery

Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.[3]

Therapeutic Endoscopy

Endoscopic drainage of the pancreatic duct is less successful than surgical drainage and does not shorten the hospital stay.[4][5]

References

1. ^ 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. 
2. ^ Warshaw AL, Banks PA, Fernández-Del Castillo C (1998). "AGA technical review: treatment of pain in chronic pancreatitis". Gastroenterology 115 (3): 765-76. PMID 9721175. 
3. ^ Society for Surgery of the Alimentary Tract (SSAT) (2004). Operative treatment for chronic pancreatitis.. Retrieved on 2007-06-09.
4. ^ Cahen DL, Gouma DJ, Nio Y, et al (2007). "Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis". N. Engl. J. Med. 356 (7): 676-84. DOI:10.1056/NEJMoa060610. PMID 17301298. 
5. ^ Díte P, Ruzicka M, Zboril V, Novotnı I (2003). "A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis". Endoscopy 35 (7): 553-8. DOI:10.1055/s-2003-40237. PMID 12822088. 

See also

External links

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Health science - Medicine - Digestive system - Gastroenterology (primarily , )
EsophagusGERD - Achalasia - Boerhaave syndrome - Zenker's diverticulum - Mallory-Weiss syndrome - Barrett's esophagus - Esophageal cancer - Esophageal varices
StomachGastric ulcer - Non-ulcer dyspepsia - Gastroparesis - Pyloric stenosis - Malabsorption  (e.g. celiac disease, giardiasis) - Stomach cancer
Small intestineDuodenal ulcer - Intussusception - Malabsorption (e.g. celiac, lactose intolerance, fructose malabsorption, Whipple's) - Abdominal angina
ColonDiarrhea - Appendicitis - Bowel obstruction - Diverticulitis - Diverticulosis - IBD (Crohn's, Ulcerative colitis) - IBS - Constipation - Megacolon (Toxic megacolon) - Anal fissure - Anal fistula - Anal abscess - Rectal prolapse
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LiverAlcoholic liver disease - Cholestasis - Liver failure - Cirrhosis - Hepatitis - PBC - NASH - Fatty liver - Peliosis hepatis - Portal hypertension - Hepatorenal syndrome - Budd-Chiari - Hepatocellular carcinoma
Accessory digestiveGallbladder/Biliary tree (Gallstones, Choledocholithiasis, Cholecystitis, Cholangitis, PSC, Biliary fistula, Ascending cholangitis) - Pancreas (Acute pancreatitis, Chronic pancreatitis, Pancreatic pseudocyst, Hereditary pancreatitis, Pancreatic cancer)
OtherTropical sprue - Hematemesis - Melena - Gastrointestinal bleeding (Upper, Lower) - Peritonitis
See also
Pancreatitis
Classification & external resources

ICD-10 K 85. , K 86.0 -K 86.1
ICD-9 577.0 - 577.1

eMedicine emerg/354   Pancreatitis is inflammation of the pancreas. See also acute pancreatitis and chronic pancreatitis for more details.
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Inflammation (Latin, inflammatio, to set on fire) is the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.
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The pancreas is a gland organ in the digestive and endocrine systems of vertebrates<ref name="New Standard" />. It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including
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Inflammation (Latin, inflammatio, to set on fire) is the complex biological response of vascular tissues to harmful stimuli, such as pathogens, damaged cells, or irritants.
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The pancreas is a gland organ in the digestive and endocrine systems of vertebrates<ref name="New Standard" />. It is both exocrine (secreting pancreatic juice containing digestive enzymes) and endocrine (producing several important hormones, including
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Abdominal pain
Classifications and external resources

ICD-10 R 10.
ICD-9 789.0

Abdominal pain can be one of the symptoms associated with transient disorders or serious disease.
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Steatorrhoea is the formation of bulky, grey or pale faeces. Stools may also float (due to excess gas from carbohydrate malabsorption), have an oily appearance or be foul smelling. There is increased fat excretion, which can be measured by determining the faecal fat level.
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MeSH D003967 Diarrhea (in American English) or diarrhoea (in British English) is a condition in which the sufferer has frequent watery, loose bowel movements (from the Greek word διάρροια; literally meaning "through-flowing").
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Nausea
Classifications and external resources

ICD-10 R 11.
ICD-9 787.0

Nausea (Latin: Nausea, Greek: Ναυτεία
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MeSH D015431 Weight loss, in the context of medicine or health or physical fitness, is a reduction of the total body weight, due to a mean loss of fluid, body fat or adipose tissue and/or lean mass, namely bone mineral deposits, muscle, tendon and other connective tissue.
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Idiopathic is an adjective used primarily in medicine meaning arising spontaneously or from an obscure or unknown cause. From Greek ἴδιος, idios (one's own) + παθος, pathos (suffering), it means approximately "a
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Cystic fibrosis
Classification & external resources

ICD-10 E 84.
ICD-9 277

OMIM 219700
DiseasesDB 3347
MedlinePlus 000107
eMedicine ped/535  
MeSH D003550 Cystic fibrosis (CF
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Amylase is the name given to glycoside hydrolase enzymes that break down starch into glucose molecules. Amylase is also known as Ptyalin. Although the amylases are designated by different Greek letters, they all act on α-1,4-glycosidic bonds.
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lipase is a water-soluble enzyme that catalyzes the hydrolysis of ester bonds in water–insoluble, lipid substrates[1]. Lipases thus comprise a subclass of the esterases.
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Triglyceride   (help info ) (more properly known as triacylglycerol   (help info ) or triacylglyceride
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X-rays (or Röntgen rays) are a form of electromagnetic radiation with a wavelength in the range of 10 to 0.01 nanometers, corresponding to frequencies in the range 30 PHz to 30 EHz. X-rays are primarily used for diagnostic radiography and crystallography.
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Medical ultrasonography (sonography) is an ultrasound-based diagnostic imaging technique used to visualize muscles and internal organs, their size, structures and possible pathologies or lesions.
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Computed tomography (CT), originally known as computed axial tomography (CAT or CT scan) and body section roentgenography, is a medical imaging method employing tomography where digital geometry processing is used to generate a three-dimensional image of the
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Magnetic resonance imaging (MRI), formerly referred to as magnetic resonance tomography (MRT) and, in scientific circles and as originally marketed by companies such as General Electric, nuclear magnetic resonance imaging (NMRI) or NMR zeugmatography imaging
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Magnetic resonance cholangiopancreatography (MRCP) is a medical imaging technique which uses magnetic resonance imaging to visualise the biliary and pancreatic ducts in a non-invasive manner.
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Endoscopic retrograde cholangiopancreatography (ERCP) is a technique that combines the use of endoscopy and fluoroscopy to diagnose and treat certain problems of the biliary or pancreatic ductal systems.
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Dystrophic Calcification (D.C.) is the mineralization of soft tissue without a systemic mineral imbalance. A systemic imbalance would elevate calcium levels in the blood and all tissues: metastatic calcification.
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Diabetes mellitus
Classification & external resources

ICD-10 E 10. –E 14.
ICD-9 250

MedlinePlus 001214
eMedicine med/546   emerg/134

MeSH C18.452.394.
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An analgesic (colloquially known as a painkiller) is any member of the diverse group of drugs used to relieve pain (achieve analgesia). The word analgesic derives from Greek an- ("without") and -algia ("pain").
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Steatorrhoea is the formation of bulky, grey or pale faeces. Stools may also float (due to excess gas from carbohydrate malabsorption), have an oily appearance or be foul smelling. There is increased fat excretion, which can be measured by determining the faecal fat level.
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digital object identifier (or DOI) is a permanent identifier given to a document, which is not related to its current location. A typical use of a DOI is to give a scientific paper or article a unique identifying number that can be used by anyone to locate details of the paper, and
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digital object identifier (or DOI) is a permanent identifier given to a document, which is not related to its current location. A typical use of a DOI is to give a scientific paper or article a unique identifying number that can be used by anyone to locate details of the paper, and
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Acute pancreatitis
Classification & external resources

Pancreas
ICD-10 K 85.
ICD-9 577.0

DiseasesDB 9539
MedlinePlus 000287
eMedicine med/1720   radio/521

Acute pancreatitis is rapidly-onset inflammation of the pancreas.
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Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack of digestive enzymes made by the pancreas. This disease is found frequently in dogs. EPI is also found in humans afflicted with cystic fibrosis.
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Health science is the applied science dealing with health, and it includes many subdisciplines. See also health science academic disciplines.

There are two approaches to health science: the study and research of the human body and health-related issues to understand
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