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Pancreatitis (Chronic)

Chronic pancreatitis is a long-term inflammation of the pancreas that leads to permanent damage and impairment of its structure and function. The pancreas is a gland located behind the stomach, responsible for producing digestive enzymes and hormones like insulin. Chronic pancreatitis disrupts these functions, leading to digestive problems and, in severe cases, diabetes.

Chronic pancreatitis is a long-term inflammation of the pancreas that leads to permanent damage and impairment of its structure and function. The pancreas is a gland located behind the stomach, responsible for producing digestive enzymes and hormones like insulin. Chronic pancreatitis disrupts these functions, leading to digestive problems and, in severe cases, diabetes.

Key Features

  1. Chronic Inflammation:
    • Unlike acute pancreatitis, which is sudden and often reversible, chronic pancreatitis involves persistent inflammation.
  2. Progressive Damage:
    • Over time, the inflammation causes scarring (fibrosis), calcification, and loss of pancreatic function.
  3. Exocrine and Endocrine Dysfunction:
    • Exocrine dysfunction: Reduced production of digestive enzymes, leading to malabsorption.
    • Endocrine dysfunction: Impaired insulin production, which may result in diabetes (referred to as pancreatogenic or Type 3c diabetes).

Causes

The primary causes include:

  • Alcohol abuse (most common in adults).
  • Genetic factors, such as mutations in the PRSS1 or CFTR genes (linked to cystic fibrosis).
  • Autoimmune pancreatitis.
  • Recurrent acute pancreatitis.
  • Gallstones (less common in chronic cases).
  • Obstruction of the pancreatic duct due to tumors or strictures.
  • Idiopathic: In some cases, the cause is unknown.

Symptoms

  • Persistent abdominal pain, often in the upper abdomen, radiating to the back.
  • Steatorrhea (fatty, foul-smelling stools) due to fat malabsorption.
  • Weight loss and malnutrition despite adequate food intake.
  • Diabetes symptoms, such as increased thirst, frequent urination, or fatigue (in advanced stages).
  • Nausea and vomiting during flare-ups.

Diagnosis

  1. Imaging Studies:
    • CT Scan or MRI: Shows calcifications, ductal irregularities, or scarring in the pancreas.
    • Endoscopic Ultrasound (EUS): Helps detect early changes in the pancreas.
  2. Function Tests:
    • Fecal elastase test: Measures the amount of elastase enzyme in stool to assess exocrine function.
  3. Blood Tests:
    • May show mild elevation of pancreatic enzymes during flare-ups.
  4. Glucose Tolerance Test:
    • Evaluates for diabetes caused by pancreatic damage.

Treatment

  1. Lifestyle Modifications:
    • Avoid alcohol and smoking (crucial for slowing disease progression).
    • High-calorie diet with low fat and vitamin supplements to address malnutrition.
  2. Medications:
    • Pancreatic enzyme supplements: Aid digestion and reduce steatorrhea.
    • Pain management: Non-opioid analgesics initially; severe pain may require stronger medications or interventions.
    • Insulin therapy: For managing diabetes.
  3. Endoscopic or Surgical Interventions:
    • Drainage of cysts or removal of ductal obstructions.
    • Pancreatic resection or procedures like the Puestow procedure in severe cases.

Complications

  • Chronic pain: Can be debilitating.
  • Malnutrition: Due to poor digestion and absorption of nutrients.
  • Pancreatic insufficiency: Leads to severe digestive problems.
  • Diabetes: Often irreversible in advanced stages.
  • Pancreatic cancer: Increased risk over time.

Prognosis

Chronic pancreatitis is a progressive disease. While treatments can relieve symptoms and manage complications, the damage is irreversible. Early diagnosis and lifestyle changes can significantly improve quality of life and slow progression.