Pancreatitis%20-%20chronic Signs and Symptoms

• 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 

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

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