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 Signs and Symptoms

Definition

  • Chronic pancreatitis develops from irreversible scarring sustained by the pancreas from prolonged inflammation resulting in exocrine and endocrine dysfunction
  • It is defined currently as a pathologic pancreatic inflammatory syndrome in persons with environmental, genetic and/or other risk factors who develop persistent pathologic responses to stress or injury to the parenchyma 

Signs and Symptoms

Abdominal Pain

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

Maldigestion and Steatorrhea (Exocrine Insufficiency)

  • Symptoms of fat, protein and carbohydrate maldigestion become more apparent with advanced chronic pancreatitis
  • Diarrhea with bulky, foul-smelling or oily stools may be present
  • Weight loss is not always seen even with 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
  • Malnutrition is common in patients with chronic pancreatitis and may be caused by abdominal pain, decreased food intake, diabetes mellitus (DM), pancreatic insufficiency, alcohol abuse and smoking 
  • Watery diarrhea, abdominal cramps and excess gas are uncommon

Development of Diabetes Mellitus (Endocrine Insufficiency)  

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

Etiology

Causes of Chronic Pancreatitis

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 and reduces serum trypsin inhibitory capacity and 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 and protein secretion
  • May lead to both acute and chronic pancreatitis

Hypercalcemia

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

Other Causes

  • Genetic polymorphisms, recurrent attacks of acute pancreatitis
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