Chronic pancreatitis

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Chronic pancreatitis
Other namesPancreatitis – chronic – discharge[1]
Axial CT showing multiple calcifications in the pancreas in a patient with chronic pancreatitis
SpecialtyGastroenterology Edit this on Wikidata
SymptomsNausea and vomiting[2][3]
ComplicationsExocrine pancreatic insufficiency, Endocrine pancreatic insufficiency (Type 3c diabetes), pancreatic pseudocyst,[4] pancreatic cancer,[4] vitamin deficiency (fat-soluble vitamins)[4]
CausesAlcohol(ism), Immune disorder[5]
Diagnostic methodSerum trypsinogen, Fecal fat test[2]
TreatmentPain medicines, avoiding alcohol(and smoking), among other possible management efforts[2]
Frequency50 per 100,000 persons (prevalence)

Chronic pancreatitis is a long-standing

alcohol misuse are two of the most frequently implicated causes, and the two risk factors are thought to have a synergistic effect with regards to the development of chronic pancreatitis.[4] Chronic pancreatitis is a risk factor for the development of pancreatic cancer.[4]

Signs and symptoms

There have been three symptom profiles described in those with chronic pancreatitis. Type A involves intermittent, severe symptom flare-ups with or without objective pancreatitis amongst a background of symptom-free periods. The type A symptom profile is usually more common early in the course of chronic pancreatitis.[4] Type B chronic pancreatitis involves chronic pain accompanied by intermittent severe attacks.[4] And, the type C symptom profile of chronic pancreatitis involves chronic, long-term, severe pain without interspersed acute flare-ups or symptom exacerbations.[4]

Causes

Among the causes of chronic pancreatitis are the following:[5]

Chronic

autosomal dominant fashion.[4] Almost all patients with cystic fibrosis have established chronic pancreatitis, usually from birth. Cystic fibrosis gene mutations have also been identified in patients with chronic pancreatitis but in whom there were no other manifestations of cystic fibrosis. Obstruction of the pancreatic duct because of either a benign or malignant process may result in chronic pancreatitis.[9]

Pathophysiology

PRSS1

The mechanism of chronic pancreatitis viewed from a genetic standpoint indicates early onset of severe

PRSS1, and mutation, R122H. R122H is the most common mutation for hereditary chronic pancreatitis with replacement of arginine with histidine at amino acid position 122 of the trypsinogen protein. There are, of course, other mechanisms – alcohol, malnutrition, smoking – each exhibiting its own effect on the pancreas.[10]

Diagnosis

The diagnosis of chronic pancreatitis is made based on the history and characteristics of symptoms combined with findings on radiologic imaging.[4] Serum amylase and lipase may be moderately elevated in cases of chronic pancreatitis.

Symptoms of

fecal fat test can also be done to quantify the fat levels in the stool and confirm the presence of exocrine pancreatic insufficiency.[4]

When chronic pancreatitis is caused by genetic factors, elevations in

ANA and anti-smooth muscle antibody may be detected.[11]

stones or strictures.[4][12]
A biopsy of the pancreas is not required for the diagnosis.[4] On imaging, pancreatic and bile duct dilatation, atrophy of the pancreas, multiple calcifications of the pancreas, and enlargement of pancreatic glands can be found.[12]

On MRI scan, there is a low T1 signal due to inflammation, fibrosis, focal lesions, and calcifications. In those who are given a contrast agent, there would be a higher T1 signal with late gadolinium enhancement due to compression from the fibrotic areas. The overall thickness of the pancreas will be reduced.[12]

Treatment

The different treatment options for the management of chronic pancreatitis are medical measures, therapeutic endoscopy, and surgery.

Antioxidants may help, but it is unclear if the benefits are meaningful.[15]

Endoscopic treatments, including removal of stones in the

Extracorporeal shockwave lithotripsy can also be done, in which external acoustic waves are administered to break the stones. This may be combined with endoscopic retrograde cholangiopancreatography to collect larger stones.[4]

Behavioral treatments such as

addiction treatment may also be used as adjunct treatments.[4]

Pancreatic enzymes

Pancreatic enzyme replacement is often effective in treating the malabsorption and steatorrhea associated with chronic pancreatitis. Treatment of CP consists of the administration of a solution of pancreatic enzymes with meals. Some patients do have pain reduction with enzyme replacement, and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without the involvement of large ducts and those with idiopathic pancreatitis.[16]

Surgery

Surgery to treat chronic pancreatitis tends to be divided into two areas – resectional and drainage procedures. Among the reasons to opt for surgery is if there is a pseudocyst,

total pancreatectomy with or without autologous islet cell transplantation (removal of the whole pancreas, which is usually reserved for cases refractory to other surgical and medical interventions) may be used for treatment of chronic pancreatitis.[17][4]

Epidemiology

The annual incidence of chronic pancreatitis is 5 to 12 per 100,000 persons, the prevalence is 50 per 100,000 persons.[18] It has been reported that the pancreas is able to absorb radioactive

Type 3c (pancreatogenic) diabetes.[19]

See also

References

  1. ^ a b "Chronic pancreatitis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-11-29.
  2. ^ a b c d e f g "Chronic pancreatitis". When scarring of the pancreas occurs, the organ is no longer able to make the right amount of these enzymes. As a result, your body may be unable to digest fat and key elements of food. Damage to the parts of the pancreas that make insulin may lead to diabetes
  3. ^ a b c d "What is chronic pancreatitis?". diabetes; upper abdominal pain that is frequently chronic and debilitating. Pain is the most common symptom of chronic pancreatitis. The pain may increase after drinking or eating and lessens when fasting or sitting and leaning forward. However, some people with chronic pancreatitis report little to no pain; from google (chronic pancreatitis smelly poop) result 1
  4. ^
    S2CID 247221549
    .
  5. ^ a b c "Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology". 2018-11-11. {{cite journal}}: Cite journal requires |journal= (help)
  6. PMID 24259953
    .
  7. ^ "Chronic Pancreatitis". The Lecturio Medical Concept Library. 11 November 2020. Retrieved 9 July 2021.
  8. ^ Action, Pancreatic Cancer. "Type 3C diabetes (secondary diabetes) Pancreatic Cancer Symptoms". Pancreatic Cancer Action.
  9. ^ Choices, NHS. "Chronic pancreatitis – Causes – NHS Choices". www.nhs.uk. Retrieved 2015-11-29.
  10. PMID 24259953
    .
  11. ISBN 9781493919925
    .
  12. ^
    PMID 31367093
    .
  13. ^
    PMID 9721174. {{cite journal}}: |author= has generic name (help) – via ScienceDirect
     (Subscription may be required or content may be available in libraries.)|Available online 27 October 2005
  14. PMID 24259958
    .
  15. S2CID 20024219
    .
  16. PMID 20510833. – via ScienceDirect
     (Subscription may be required or content may be available in libraries.)
  17. ^ Nikolaidis, Paul; Meranda, Joseph; Miller, Frank; Summers, Allison; Gabriel, Helena; Talamonti, Mark; Gore, Richard. "Puestow Procedure – an overview ScienceDirect Topics". www.sciencedirect.com. Saunders.
  18. PMID 23622135
    .
  19. PMID 34501532. Text was copied from this source, which is available under Creative Commons Attribution 4.0 International License
    .

Further reading

External links

Scholia has a topic profile for Chronic pancreatitis.
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