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PauliPuolakkainen

Chronic Pancreatitis

Essentials

  • Withdrawal of alcohol before the disease emerges
  • Consider chronic pancreatitis as the cause of recurrent upper abdominal pain, weight loss and diarrhoea.
  • Detect diabetes at an early stage in patients with chronic pancreatitis. Be careful not to induce hypoglycaemia in patients on insulin.
  • Chronic pancreatitis is associated with an elevated risk of pancreatic cancer.

Aetiology

  • Recurring acute pancreatites may lead to chronic pancreatitis.
  • Alcohol is a causative factor in up to 90% of cases
    • With few exceptions the patient is a heavy drinker who has consumed 150-175 g of pure alcohol daily over 10-15 years before disease onset
  • Gallstone disease
  • Metabolic disorders (hypertriglyceridaemia, hyperparathyroidism)
  • Hereditary chronic pancreatitis (hereditary pancreatic calcification)
  • The autoimmune form of chronic pancreatitis is associated with primary sclerosing cholangitis Primary Sclerosing Cholangitis, primary biliary cirrhosis Primary Biliary Cholangitis, and Sjögren's syndrome Primary Sjögren's Syndrome.

Symptoms

  • Upper abdominal pain that radiates to the back with possibly associated nausea and vomiting; weight loss, jaundice.
  • The pain is caused by increased ductal pressure and by neuritis.
  • Within approx. 8 years 50% of the patients develop endocrine and exocrine pacreatic insufficiency manifested as steatorrhoea, weight loss and diabetes Pancreatic Insufficiency.

Diagnosis

Examinations in primary care

Conservative treatment

Indications for specialist consultation

  • The diagnosis of chronic pancreatitis is based on imaging (CT, MRCP, ERCP, PET, endoscopic ultrasound http://www.dynamed.com/condition/chronic-pancreatitis#ENDOSCOPIC_GUIDED_ULTRASOUND__EUS_). Therefore, the confirmation of the diagnosis, including differential diagnostics (e.g., pancreatic cancer), often require hospital examinations.
  • Recurrent bouts of severe pain
  • Suspected complications
    • Pancreatic pseudocyst
      • Symptoms: pain, bowel obstruction, biliary obstruction
      • Treatment: ERCP and stenting / endoscopic or operative pseudocyst-gastrostomy / pancreatic resection
    • Pancreatic pseudocyst / bleeding pseudoaneurysm
      • Treatment: endovascular coiling or operative treatment
    • Pancreatic fistulae
      • Treatment: endoscopic / operative
    • Infected pancreatic pseudocyst
      • Treatment: draining and antibiotics
    • Biliary obstruction
      • Treatment: ERCP and stenting