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Chronic
pancreatitis
Unlike
acute pancreatitis, in
chronic pancreatitis destruction of the pancreas persists sometimes
even when the
underlying causes are removed.
Alcohol abuse is the most common cause.
Clinical suspicion
Pancreatic pain (severe agonizing
epigastric pain which may radiate to the back accompanied by nausea and
vomiting) accompanied by steatorrhoea and loss of weight.
Diagnosis
Elevations of serum amylase and lipase are found only during
acute attacks of pancreatitis, usually early in the course of the
disease. In the later stages of chronic pancreatitis, atrophy of the
pancreatic parenchyma can result in serum enzyme levels within the
reference range, even during acute attacks of pain.
Abdominal x-ray: Pancreatic calcifications, often considered
pathognomonic of chronic pancreatitis, are observed in approximately
30% of cases.
Calcified shrunken pancreas
can be detected by abdominal CT scan in advanced cases. CT is less
sensitive in early or moderate cases.
ERCP is the diagnostic procedure of choice. It allows the most
accurate visualization of the pancreatic ductal system and has been
regarded as the criterion standard for diagnosing chronic
pancreatitis. One limitation of ERCP is that it cannot be used to
evaluate the pancreatic parenchyma, and histologically proven
chronic pancreatitis has been documented in the setting of normal
findings on pancreatogram.
Endoscopic ultrasonography and Magnetic resonance
cholangiopandreatography (MRCP) are being reviewed and improved as
methods of diagnosis.
Treatment
Conservative measures as acute pancreatitis. Antioxidant vitamin
and micronutrient supplementation may have a role in facilitating
pancreatic healing. Pain control involves pethidine or may require
celiac ganglion blockade.
Surgery is indicated in cases accompanied by biliary obstruction and
complications as pseudocysts. Pancreatic resection: may be an option
If the disease is limited to the head of the pancreas. However,
pancreatic function and quality of life are impaired after these
procedures, and the operative mortality rate of total pancreatectomy
is about 10%. Total pancreatectomy and islet autotransplantation is
used in selected patients to avoid the morbidity of diabetes
following pancreatectomy.
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