Pancreatitis%20-%20chronic Management

• Complications of chronic pancreatitis result from endocrine and exocrine insufficiency
• Other complications such as a pancreatic pseudocyst, gastroparesis due to chronic pancreatitis, duodenal or biliary obstruction, or a secondary pancreatic cancer should be identified and treated accordingly

Diabetes Mellitus

• Diabetes results from destruction of pancreatic acinar cells
  • Insulin secretion is not completely lost while glucagon secretion is reduced
• Treatment is often directed at controlling urinary glucose losses rather than blood sugar levels
  • Avoid tight control of glucose levels as treatment-induced hypoglycemia can be fatal especially in malnourished patients
• Insulin is usually required, but some patients may still respond to oral antidiabetic agents
• Monitor patients for complications of long-standing diabetes eg nephropathy, neuropathy and retinopathy

Maldigestion

• Enzyme supplementation with lipase during and after a meal may reduce steatorrhea
• Supplementation with fat-soluble vitamins is beneficial and MCTs can help prevent weight loss
• Screen patients for micronutrient and macronutrient deficiencies at least annually  
• Periodically assess for malnutrition including tests for osteoporosis 
• Response to treatment may be measured through loss of visible stool fat, improved stool consistency, weight gain and normalization of fat-soluble vitamin levels

Pancreatic Malignancy

• Although the prevalence of pancreatic ductal adenocarcinoma is high in patients with chronic pancreatitis, there is currently no definitive benefit in screening patients for pancreatic malignancy