Chronic Pancreatitis

Chronic pancreatitis is a condition where a patient experiences long-term inflammation and subsequent damage of the pancreas. It does not heal and gets worse over time and causes alterations in the normal functions and structure of the organ. Risk factors include persistent pain or malabsorption and acute inflammations of the pancreas as a result of prior injuries. When the pancreas is scarred, it is unable to produce enzymes and as a result cannot digest the fat accumulated in the system. There is also non-production of insulin, which can lead to diabetes. Alcohol is the commonest cause of chronic pancreatitis in India. Other causes are uncommon.

chronic-pancreatitis-diagram-pancreas

Causes

  • Heredity : disruption of pancreatic functions due to genetic mutations
  • Autoimmune problems
  • Blockages of common bile duct or pancreatic duct
  • Cystic fibrosis
  • Hyperparathyroidism
  • Hypertriglyceridemia: high levels of triglycerides
  • Use of medications such as azathioprine, thiazides and sulfonamides
  • Alcohol abuse
  • Smoking

Symptoms

  • Nausea and vomiting
  • Diarrhea
  • Acute weight loss with normal eating habits
  • Fatty and oily stools
  • Clay-colored stools
  • Abdominal pain lasting for days in the upper abdomen and also radiating to the back; abdominal pain gets worse with eating and drinking.

Diagnosis

Fecal fat test measures the fat in stool and absorption rates of the body.
Serum amylase measures the level of enzymes in the blood.
Serum IgG4 is done to diagnose autoimmune pancreatitis.
Serum lipase measures the level of lipase in the blood.
Serum trypsinogen is done to measure trypsinogen levels in the blood.
Abdominal CT scan produces cross-sectional pictures of the abdomen.
Abdominal ultrasound examines in the internal organs such as the spleen, pancreas and kidneys located in the belly.
Exploratory laparotomy is done to diagnose acute pancreatitis.
ERCP is a combination of fluoroscopy and endoscopy done to diagnose problems in the upper GI tract non-invasively.
EUS combining endoscopy and ultrasound, helps obtain high quality imagery using an endoscope.
MRCP scan is a non-invasive technique of visualizing pancreatic and biliary ducts.

Treatment

Surgery is the primary treatment and helps relieving pain by decompressing the pancreatic duct. Sometimes a reasonable amount of pancreatic parenchyma is cored out to alleviate pain originating from the head of the pancreas. Abstinence from alcohol is mandatory.