Chronic Pancreatitis

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What causes chronic pancreatitis?

There are several causes of chronic pancreatitis. The main causes are following:

  • Excess alcohol intake is the commonest cause .
  • Idiopathic
  • Tropical pancreatitis
  • Hypercalcemia
  • Hypertriglyceridemia
  • Hereditary
  • Repeated attack of acute pancreatitis
  • Pancreatic duct stricture/Congenital abnormality (pancreatic divisum)
  • Autoimmune pancreatitis

Symptoms
  • Pain is the most disabling symptom.
  • Diabetes , about 30% of the chronic pancreatitis patient develop diabetes.
  • Loose , greasy stool
  • Jaundice, if it invoives the lower end of the bile duct.
  • Weight loss can occur
  • Compression of the duodenum can lead to vomiting
  • Bleeding into the gut can sometimes be the first symptom

Test
  • Blood test to see if you have already develop diabetes or not.
    Pancreatic enzyme assessment is not rotuiely done in clinical practice.
  • CT scan/MRCP is done to look at the pancreatic structural changes and diagnose chronic pancreatitis.
  • EUS( endo ultrasound) some is done to diagnose chronic pancreatitis.

Treatment

All patient of chronic pancreatitis need to undersand problems arising due to the disease can be managed medically or surgically though there is no cure for the disease at present.

  • Pain relief: all patient are given pain killers initially to control the pain but if it still continue to affect them, surgical intervention can cure pain upto 90% of the patient.
  • Diabetes : medical management
  • Pancreatic enzyme deficiency: Pancreatic enzymes to be taken at the time of meals
  • Surgical procedures: These are indicated in following condition
  1. Intractable pain
  2. Pancreatic duct stenosis (narrowing)
  3. Cysts and pseudocysts
  4. Biliary obstruction
  5. Duodenal obstruction
  6. Suspicion of cancer
  7. Portal or splenic vein thrombosis
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