Chronic pancreatitis is a disease process characterized by irreversible damage to the pancreas.
Alcoholism is the most frequent cause of clinically apparent chronic pancreatitis; in 25% of adults, etiology is unknown. Other causes are listed in Table 154-3 Chronic Pancreatitis and Pancreatic Exocrine Insufficiency: TIGAR-O Classification System.
Pain is cardinal symptom. Weight loss, steatorrhea, and other signs and symptoms of malabsorption common. Physical examination often unremarkable.
No specific laboratory test for chronic pancreatitis. Serum amylase and lipase levels are often normal. Serum bilirubin and alkaline phosphatase may be elevated. The fecal elastase-1 and small-bowel biopsy are useful in the evaluation of pts with suspected pancreatic steatorrhea. Many pts have impaired glucose tolerance. Secretin stimulation test is a relatively sensitive test for pancreatic exocrine deficiency and becomes abnormal when ≥60% of the pancreatic exocrine function has been lost.
CT scan is the imaging modality of choice followed by MRI, endoscopic ultrasound, and pancreas function testing. Diffuse calcifications noted on plain film of the abdomen usually indicate significant damage to the pancreas and are pathognomic for chronic pancreatitis.
Important to distinguish from pancreatic carcinoma; may require radiographically guided biopsy.
| TREATMENT | ||
Chronic PancreatitisAimed at controlling malabsorption and pain. Pancreatic enzyme replacement has been the cornerstone of therapy as it usually controls diarrhea and restores absorption of fat to an acceptable level and allows weight gain. Because pancreatic enzymes are inactivated by acid, proton pump inhibitors may improve their efficacy (but should not be given with enteric-coated preparations). The management of pain in pts with chronic pancreatitis is problematic. Recent meta-analyses have shown no consistent benefit of enzyme therapy at reducing pain in chronic pancreatitis. A recent prospective study reported that pregabalin can improve pain in chronic pancreatitis and lower pain medication requirement. Surgery with ductal decompression may control pain if there is a large-duct disease. Subtotal pancreatectomy may also control pain but at the cost of exocrine insufficiency and diabetes. |