Information
Editors
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
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