DefinitionThe pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin. Chronic pancreatitis is a progressive inflammation of the pancreas marked by frequent acute attacks and risk of permanent organ damage.
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CausesChronic pancreatitis results from prolonged injury, toxic exposure, autoimmune disease, or obstruction of the pancreas.
Risk FactorsChronic pancreatitis is more common in men. Other factors that may increase your risk of chronic pancreatitis include:Personal health history, such as:
- Excess alcohol intake
- Recurrent attacks of acute pancreatitis
- Family history of:
- Hyperparathyroidism associated with chronic pancreatitis
- Chronic pancreatitis
- Chronic kidney disease
- Congenital conditions, such as pancreas divisum
- Ischemia—insufficient blood supply to the pancreas
- Hyperlipidemia —elevated blood fat levels
- Hypertriglyceridemia —elevated blood triglyceride levels
- Hypercalcemia —elevated blood calcium levels
- Cystic fibrosis
- Pseudocysts—build up of fluids and debris
SymptomsSymptoms may be mild, but progressive. Chronic pancreatitis may cause:
- Abdominal pain that may get worse when eating or drinking, spreads to the back, or becomes constant and disabling
- Nausea and vomiting
- Weight loss
DiagnosisYou will be asked about your symptoms and medical history. A physical exam will be done. The diagnosis of chronic pancreatitis is difficult. Symptoms are not specific early on in the course of the disease.Your bodily fluids and waste products may be tested. This can be done with:
- Blood tests
- Stool tests
- Abdominal ultrasound
- Abdominal CT scan
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic retrograde cholangiopancreatography (ERCP)
TreatmentThe goals of treatment for chronic pancreatitis are to relieve pain and manage nutritional and metabolic problems.Treatment may be started in a hospital until you are stabilized. Stabilization can be done with:
- IV fluids
- Nasogastric tube—A long, thin tube is threaded through your nose and into your stomach for feeding
MedicationsYour doctor may recommend:
- Prescription pain relievers
- Pancreatic enzymes
- Vitamin supplements
- Medications to control diabetes if it develops
Lifestyle ChangesYou will be advised to stop drinking alcohol. This may require counseling or a rehabilitation program. Stopping your alcohol intake is the most important intervention in your treatment. If you smoke, talk to your doctor about how you can successfully quit . You may be advised to restrict the amount of fat in your diet. Pancreatic damage interferes with the body's ability to process fats. A registered dietitian can work with you and create a healthy meal plan.
SurgerySurgery may be needed in severe cases:
- Necrosectomy—Removal of dying or dead (necrotic) pancreatic tissue. Pancreatic necrosis is more serious if an infection is present. This procedure can also be done with endoscopy.
- ECRP—To open any collapsed ducts or drain cysts.
- Cholecystectomy —To remove the gallbladder.
PreventionAside from avoiding too much alcohol, there are no current guidelines to prevent chronic pancreatitis.
National Institute of Diabetes and Digestive and Kidney Diseases
National Pancreas Foundation
Canadian Association of Gastroenterology
Chronic pancreatitis. EBSCO DynaMed website.Available at: http://www.ebscohost.com/dynamed.Updated April 17, 2014. Accessed December 9, 2014.
Chronic pancreatitis. Tulane University School of Medicine website. Available at: http://tulane.edu/som/pancreas-biliary/diseases/chronic-pancreatitis.cfm. Accessed December 9, 2014.
Grant JP. Nutritional support in acute and chronic pancreatitis. Surg Clin North Am. 2011;91(4):805-820, viii.
Pancreatitis. National Institute of Diabetes and Digestive and Kidney Diseases website. Available at: http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis. Updated August 16, 2012. Accessed December 9, 2014.
Singh VV, Toskes PP. Medical therapy for chronic pancreatitis pain. Curr Gastroenterol Rep. 2003; 5:110.
- Reviewer: Michael Woods, MD
- Review Date: 12/2014
- Update Date: 12/20/2014
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