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PANCREATITIS - CHRONIC
Chronic pancreatitis develops from irreversible scarring sustained by the pancreas from prolonged inflammation resulting in exocrine and endocrine dysfunction.
Signs and symptoms include abdominal pain that is epigastric in location which radiates to the back and frequently occurs at night or after meals, symptoms of fat, protein & carbohydrate 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 glucagon and insulin.

Surgical Intervention

  • Early surgical intervention may more effectively relieve pain, decrease the need for re-intervention and improve pancreatic function preservation 
  • Surgery may be considered in the following groups of patients:
    • With 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
    • Presence of complications, eg infection or symptomatic compression of adjacent structures 
    • As 1st-line treatment for suspected pancreatic cancer
  • Procedures that may be performed are pseudocyst decompression, ductal decompression, pancreatic resection, denervation procedures, and total pancreatectomy
  • The choice of procedure depends on the patient’s predominant condition, though more preferred are the tissue-preserving procedures
    • Ductal dilatation is best treated with drainage and decompression procedures
    • “Small-duct” disease is usually treated with pancreatic resection
    • Pseudocysts >5 cm in size and persisting for >6 months should be drained 
    • Refractory chronic pain in highly selected patients is treated with total pancreatectomy with islet autotransplant only when all other treatment measures are unsuccessful
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