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.

Definition

  • A progressive fibroinflammatory process of the pancreas that results in permanent structural damage

Pathophysiology

Chronic Pancreatitis

  •  Develops from irreversible scarring sustained by the pancreas from prolonged inflammation

Diabetes Mellitus (DM)

  • Chronic pancreatitis results in destruction of alpha & beta cells, which gives rise to deficiencies of both insulin & glucagon
  • Secondary diabetes results from the hormone deficiency

Signs and Symptoms

Abdominal Pain

  • Commonly epigastric in location, w/ radiation to the back & frequently occurs at night or after meals
  • Described as deep & piercing, may be associated w/ nausea & vomiting
  • Often severe, making it the most disabling clinical problem in patients w/ chronic pancreatitis
  • May be relieved by sitting or leaning forward, assuming the knee-chest position on one side or by squatting & bringing the knees to the chest
  • Causes decreased appetite leading to weight loss & malnutrition
  • Severe pain may also lead to narcotic dependency

Maldigestion

  • Symptoms of fat, protein & carbohydrate maldigestion become more apparent w/ advanced chronic pancreatitis
  • Diarrhea w/ bulky, foul-smelling or oily stools may be present
  • Weight loss is not always seen even w/ maldigestion, but is more common during episodes of severe pain which markedly reduce food intake
    • In cases of considerable weight loss, investigate other causes (eg pancreatic malignancy, small bowel bacterial overgrowth)
  • Watery diarrhea, abdominal cramps & excess gas are uncommon

Risk Factors

Alcohol

  • Alcoholism has been found to be the foremost cause of chronic pancreatitis in industrialized countries
  • Recurrent attacks of acute alcoholic pancreatitis can lead to chronic pancreatitis

Smoking

  • Smoking inhibits pancreatic bicarbonate secretion & reduces serum trypsin inhibitory capacity & alpha1-antitrypsin levels

Chronic Renal Failure

  • Possible mechanisms of pancreatic injury from chronic renal failure:
    • Direct damage from uremic toxins
    • Changes in regulation of bicarbonate & protein secretion
  • May lead to both acute & chronic pancreatitis

Hypercalcemia

  • High levels of calcium may lead to trypsinogen activation & trypsin stabilization
  • Explains the link between hyperparathyroidism & chronic pancreatitis
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