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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.

Surgical Intervention

  • Surgery may be considered in the following groups of patients:
    • Persistent pain unresponsive to medical therapy
    • Patients whose pancreatic ductal anatomy is not suitable for endoscopic treatment
    • Patients in whom endoscopic therapy has failed
      • Surgery is superior to endoscopy for control of pain in a dilated pancreatic duct
    • As 1st-line treatment for suspected pancreatic cancer
  • Procedures that may be performed are pseudocyst decompression, ductal decompression, pancreatic resection & denervation procedures
  • The choice of procedure depends on the patient’s predominant condition
    • Ductal dilatation is best treated w/ drainage & decompression procedures
    • “Small-duct” disease is usually treated w/ pancreatic resection

Endoscopic Retrograde Cholangiopancreatography (ERCP)

  • Considered the “de facto” gold standard because it is currently the most specific & sensitive test of pancreatic structure
    • Advantage is therapy may also be administered (eg pancreatic duct stenting or stone extraction)
  • Useful for patients in whom other tests are nondiagnostic or unavailable
  • Main disadvantage is that it is the riskiest exam for chronic pancreatitis
  • Diagnosis is based on abnormalities seen in the main pancreatic duct & its branches
  • Pathognomonic findings consist of a markedly dilated pancreatic duct w/ alternating strictures (“chain-of-lakes” appearance)
  • Finer changes seen in early disease are often subject to inter-observer interpretation variability

Magnetic Resonance Cholangiopancreatography (MRCP)

  • Test is noninvasive & does not require sedation
  • Does not readily detect calcifications or small abnormalities of the ducts
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