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