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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.

Treatment of Complications

  • Complications of chronic pancreatitis result from exocrine & endocrine insufficiency

Diabetes Mellitus (DM)

  • 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 & retinopathy)

Maldigestion

  • Advise patients to follow a low-fat diet
  • Enzyme supplementation w/ lipase during & after a meal may reduce steatorrhea
  • Supplementation w/ fat-soluble vitamins (eg vitamin D) is beneficial & MCTs can help prevent weight loss
  • Response to treatment may be measured through loss of visible stool fat, improved stool consistency, weight gain & normalization of fat-soluble vitamin levels

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