pancreatitis%20-%20chronic
PANCREATITIS - CHRONIC
Chronic pancreatitis develops from irreversible scarring sustained by the pancreas from prolonged inflammation.
Signs and symptoms include abdominal pain that is epigastric in location that radiates to the back and frequently occurs at night or after meals, symptoms of fat, protein & carbohydrates maldigestion that become apparent with advanced chronic pancreatitis and presence of diarrhea.
Chronic pancreatitis results in destruction of alpha and beta cells which gives rise to deficiencies of both insulin and glucagon.

Pancreatitis%20-%20chronic Management

Treatment of Complications

  • 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 

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