Chronic pancreatitis

Definition
Chronic pancreatitis involves persistent inflammation of the pancreas—the elongated, tapered gland located behind the stomach that secretes digestive enzymes, and the hormones insulin and glucagon.

Causes, incidence, and risk factors

Chronic pancreatitis is most often caused by alcoholism and alcohol abuse, but sometimes the cause cannot be determined. Conditions such as hyperlipidemia or hyperparathyroidism, injury, and chronic obstruction of the pancreatic duct are also associated with chronic pancreatitis. In general, any condition that causes repeated episodes of acute pancreatitis may result in chronic pancreatitis.

In this condition, inflammation and fibrosis cause the destruction of functioning glandular tissue in the pancreas. The resulting lack of pancreatic enzymes interferes with the ability to properly digest fat. The production of insulin is also affected, which may lead to diabetes.

This condition is marked by attacks of abdominal pain and digestive problems that may become more frequent as the condition progresses. Chronic pancreatitis occurs more frequently in men than in women, perhaps because alcohol-use disorders are more common in men.

Pancreatic cancer can cause symptoms and signs similar to chronic pancreatitis.

Symptoms

• Abdominal pain
  o Greatest in the upper abdomen
  o May last from hours to days
  o Eventually may be continuous
  o May be worsened by eating or drinking
  o May be worsened by alcohol consumption
  o May radiate to the back
  
• Nausea and vomiting
  
• Unintentional weight loss
  
• Fatty stools

Sitting up and leaning forward may sometimes relieve the abdominal pain associated with pancreatitis.

Pale or clay-colored stools may also be associated with this condition.

Signs and tests

• Serum lipase may be elevated, but can normalize as the disease progresses.
  
• Serum amylase may be elevated, but can normalize as the disease progresses.
  
• Serum trypsinogen may be low.
  
• Fecal fat test shows fatty stools.

Inflammation or calcium deposits of the pancreas may be evident on:

• Abdominal CT scan
  
• Abdominal ultrasound
  
• ERCP

An exploratory laparotomy may be performed to confirm the diagnosis of pancreatitis.

Treatment

Management of the symptoms of chronic pancreatitis is achieved by reducing pancreatic stimulation, alleviating indigestion caused by fat, reducing pain, and treating diabetes with the following measures:

• Eating a low-fat diet
  
• Getting adequate fat-soluble vitamins and calcium in the diet
  
• Relieving pain with analgesics or surgical nerve block
  
• Controlling blood sugar levels by giving insulin
  
• Taking supplemental pancreatic enzymes to correct underproduction

Abstinence from alcohol is required.

Surgery may be recommended if an obstruction is found. In advanced cases, part or all of the pancreas may be removed.

Expectations (prognosis)
This is a serious disease that may lead to disability and death. The risk of death may be lowered if abstinence from alcohol is maintained.

Complications

• Obstruction of the small intestine or bile ducts
  
• Pancreatic insufficiency
  o Diabetes
  o Fat malabsorption
  
• Ascites
  
• Pancreatic pseudocysts (fluid collections), which may become infected
  
• Blood clots in the splenic vein

Calling your health care provider

Call for an appointment with your health care provider if you develop symptoms of pancreatitis.

Call for an appointment with your provider if you have pancreatitis and your symptoms worsen or do not improve with treatment.

Prevention
Determining the cause of acute pancreatitis and treating it promptly may help to prevent chronic pancreatitis. Avoiding heavy consumption of alcohol dramatically reduces the risk of developing this condition.

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