Chronic pancreatitis is a long-standing inflammation of the pancreas that converts the normal structure and function of the organ. This can arise due to acute inflammation of the pancreas is injured before, or chronic damage with persistent pain or malabsorption. This is a disease process characterized by permanent damage to the pancreas which is different from the reversible changes in acute pancreatitis.
Signs and symptoms
Patients with chronic pancreatitis usually experiencing constant abdominal pain or steatorrhea resulting malabsorption of fats in food. Diabetes is a common complication of chronic pancreatic damage and may require treatment with insulin.
Weight loss is big enough, because malabsorption, evident in a high percentage of patients, and can continue to be a health problem when the condition lasts. The patient may also complain about pain associated with their food intake, especially foods that contain a high percentage of fat and protein. Some patients experience pain chronic pancreatitis. Weight loss also can be associated with a reduction in food intake in patients with severe abdominal pain.
Causes:
- Alcohol
- Smoke
- Malnutrition
- Tripsinogen and deformed proteins
- Cystic fibrosis
- Idiopathic (unknown)
- Trauma
- Hyperglycemia
In developed countries, the most common cause of chronic pancreatitis is alcohol and gallstones. The latest research shows smoking may be a risk factor high.
Worldwide, malnutrition and diet-related factors are also involved. In a small group of patients the proven hereditary chronic pancreatitis, inherited as an autosomal dominant condition with variable penetration. Almost all patients with cystic fibrosis have been having chronic pancreatitis, usually from birth. Cystic fibrosis gene mutations have also been identified in patients with chronic pancreatitis but whom no other manifestations of cystic fibrosis.
Pancreatic duct obstruction due to benign or malignant processes can result in chronic pancreatitis. Congenital abnormalities of the pancreatic duct, pancreas divisum in particular, are also involved.
Diagnosis
The diagnosis of chronic pancreatitis is typically based on tests on the structure and function of the pancreas, as direct biopsy of the pancreas is considered too risky. Serum amylase and lipase increase may not be enough in the case of chronic pancreatitis, because the level is definitely a productive cell damage, despite the high lipase is more likely to be found in two. Amylase and lipase are almost always found increases in conditions of acute inflammatory marker CRP along with higher broadly in line with the severity of the condition. A secretin stimulation test is considered the gold standard functional test for the diagnosis of chronic pancreatitis but are not often used clinically. The observation that bi-carbonate production was disrupted early chronic pancreatitis has led the reason for using these tests in the early stages of the disease (sensitivity of 95%). Other common tests used to determine chronic pancreatitis is the measurement of fecal elastase in stool, serum tripsinogen, computed tomography (CT), ultrasound, EUS, MRI, ERCP and MRCP. Pancreatic calcification can often be seen on x-rays and a CT scan.
There are research laboratories of other non-specific which is useful in the diagnosis of chronic pancreatitis. Serum bilirubin and alkaline phosphatase may increase, indicating stricturing of the common bile duct due to edema, fibrosis or cancer. When chronic pancreatitis are due to an autoimmune process, elevations in ESR, IgG4, reumatoid factor, ANA and anti-smooth muscle antibodies can be seen. Common symptoms of chronic pancreatitis, steatorrhea, can be diagnosed with two different studies: Sudan staining chemical impurities or excretion of the fekal fat 7 grams or more over the past 24 hours in 100 g fat diet. To examine pancreatic exocrine dysfunction, tests the most sensitive and specific fecal elastase, is a measurement that can be done with a single stool sample, and a value less than 200 ug/g indicates pancreatic insufficiency.
Treatment
The different treatment modalities for control of chronic pancreatitis is the Act of medical, therapeutic endoscopy and surgery. Treatment is directed, whenever possible, with the underlying cause, and for relieving pain and malabsorption. Insulin dependent diabetes mellitus may occur and need long term insulin therapy.
Abdominal pain can be very severe and require high doses of analgesics, usually including opiates. Disability issues and the most common mood, despite the early diagnosis and support can make this problem can be overcome. Cessation of alcohol consumption and diet modification (a low-fat diet) is important to manage the pain and slow the process of calcification. Antioxidants can help but it is not clear whether the benefits are useful.
Pancreatic enzymes
Replacement pancreatic enzymes are usually effective in treating the malabsorption and steatorrhea. However, the results of 6 randomized trials have convinced regarding the reduction of pain.
While the trial results on the reduction of pain with replacement pancreatic enzymes are not convincing, some patients did experience pain reduction with enzyme replacement and since it's relatively safe, giving the enzyme replacement for patients with chronic pancreatitis is an acceptable step in treatment for most patients. Treatment is more likely to be successful at them without the involvement of large channels and people with idiopathic pancreatitis. Patients with alcoholic pancreatitis is less likely to be able to respond.
Operation for chronic pancreatitis
Traditional surgery for chronic pancreatitis tends to be divided into two areas — resectional and drainage procedures. New and proven transplantation options prevent patients having diabetes after surgical removal (resection) of their pancreas.
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