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 and increased risk of developing pancreatic ductal adenocarcinoma
- 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 oxidative stress or injury to the parenchyma
Signs and Symptoms
Abdominal Pain
- Commonly epigastric in location which radiates 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
- Severe pain may also lead to narcotic dependency
- 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
Maldigestion and Steatorrhea (Exocrine Insufficiency)
- Symptoms of fat, protein and carbohydrate maldigestion become more apparent with advanced chronic pancreatitis following diminished digestive enzyme and bicarbonate secretion
- 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 glucagon and insulin
- 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
- 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, autoimmunity, recurrent attacks of acute pancreatitis