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Chronic Pancreatitis

chronic pancreatitis

The pancreas is in the upper abdomen and lies behind the stomach and intestines (guts). It makes a fluid that contains enzymes (chemicals) that are needed to digest food. The enzymes are made in the pancreatic cells and are passed into tiny ducts (tubes). These ducts join together like branches of a tree to form the main pancreatic duct. This drains the enzyme-rich fluid into the duodenum (the part of the gut just after the stomach). The enzymes are in an inactive form in the pancreas. They are 'activated' in the duodenum to digest food.

Groups of special cells called 'Islets of Langerhans' are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed directly into the bloodstream to control the blood sugar level.

What is pancreatitis?

Pancreatitis means inflammation of the pancreas. There are two types:

  • Acute pancreatitis - when the inflammation develops quickly, over a few days or so. It often goes away completely and leaves no permanent damage. Sometimes it is serious.
  • Chronic pancreatitis - when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage.
What are the causes of chronic pancreatitis?
  • Alcohol - is the common cause. Men aged 40-50 are the most common group of people affected. In most cases the person has been drinking heavily for 10 years or more before symptoms first begin.
  • Genetic - there are some rare genetic conditions which can lead to chronic pancreatitis developing. Cystic fibrosis can be one cause.
  • Autoimmune - this is where your own immune system attacks the pancreas. This can be associated with other autoimmune diseases. For example, Sjörgren's syndrome and primary biliary cirrhosis.
  • Other causes - are uncommon. They include abnormalities of the pancreas such as narrowing of the pancreatic duct (due to various reasons) and rare hereditary causes.
  • Malnutrition - and eating lots of cassava may be a cause in some countries.
What happens in chronic pancreatitis?

A persistent inflammation develops in the pancreas. Over time the inflammation causes scarring and damage to parts of the pancreas. This can then lead to not enough enzymes and insulin being made. A lack of enzymes causes poor digestion of food (malabsorption). A lack of insulin causes diabetes.

Over time clumps of calcium are deposited and can form stones in the pancreas. Calcium stones and/or scarring of the pancreatic ducts may block the flow of enzymes along the pancreatic ducts.

What are the symptoms of chronic pancreatitis?
  • Abdominal pain - just below the ribs is a common. The pain is typically felt spreading through to the back. It tends to be persistent and may be partly eased by leaning forward. It may be mild at first but can become severe. Eating often makes the pain worse. This may lead to your eating less and then losing weight.
  • Poor digestion (malabsorption) - occurs if not enough enzymes are made by the damaged pancreas. In particular, the digestion of fats and certain vitamins is affected. This causes pale, smelly, loose stools that are difficult to flush away (steatorrhoea). Weight loss can also occur if food is not fully digested.
  • Diabetes - occurs in about 1 in 3 cases. This occurs when the pancreas cannot make sufficient insulin.
How is chronic pancreatitis diagnosed? Unfortunately, there is currently no single test for chronic pancreatitis.

Once the damage and scarring to the pancreas is more severe, or when calcium stones start to form, then the damaged pancreas can be detected by X-rays or scans.

Tests done usually include:

  • Blood tests to check your blood count, kidney and liver function.
  • Blood tested for diabetes.
  • Your doctor may also request a sample of your feces for testing.
  • An X-ray or CT scan of your abdomen may be performed.
  • A cholangiogram is a test which produces a picture of the bile ducts. This is often done using an MRI scan.
What are the complications that can develop?
  • Pseudocyst - develops in about 1 in 4 people with chronic pancreatitis. This is when pancreatic fluid, rich in enzymes, collects into a cyst due to a blocked pancreatic duct. These can swell to various sizes. They may cause symptoms such as worsening pain, feeling sick and vomiting. Sometimes they go away without treatment. Sometimes they need to be drained or surgically removed.
  • Ascites - sometimes occurs. This is fluid that collects in the abdominal cavity between the organs and guts.
  • Blockage of the bile duct - is an uncommon complication. This causes jaundice as bile cannot get into the gut and leaks into the bloodstream.
  • Cancer of the pancreas - is more common than average in people with chronic pancreatitis. The risk increases in smokers and with increasing age.
What is the treatment for chronic pancreatitis?
  1. Stop drinking alcohol for good.
  2. Painkillers - are usually needed to ease the pain.
  3. Capsules containing artificial enzymes are taken with meals.
  4. Restricting fat in the diet - may be advised if steatorrhoea is bad.
  5. Insulin - if diabetes develops
  6. Vitamins - may be needed to be taken.
  7. Do not smoke.
Surgery

Most people with chronic pancreatitis do not need surgery but an operation is sometimes needed. The common reason for surgery is for persistent bad pain that is not helped by painkillers or other methods. The operation usually involves removing part of the pancreas.

Surgery may also be needed if a complication develops. For example, if a blocked bile duct or pseudocyst develops. What is the outlook (prognosis) for chronic pancreatitis?

If you continue to drink alcohol and pancreatitis becomes severe than life expectancy is typically reduced by 10-20 years. This is due to complications of pancreatitis or to other alcohol-related illnesses. If you stop drinking alcohol completely in the early stages of the condition then the outlook is better.


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