Chronic pancreatitis is a long-standing
inflammation of the pancreas that alters the organ's normal structure and functions.
It can present as episodes of acute
inflammation
Inflammation (from la, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or irritants, and is a protective response involving immune cells, blood vessels, and molec ...
in a previously injured
pancreas
The pancreas is an organ of the digestive system and endocrine system of vertebrates. In humans, it is located in the abdomen behind the stomach and functions as a gland. The pancreas is a mixed or heterocrine gland, i.e. it has both an ...
, or as chronic damage with persistent pain or
malabsorption. It is a disease process characterized by irreversible damage to the pancreas as distinct from reversible changes in
acute pancreatitis.
Signs and symptoms
* Upper abdominal pain: Upper abdominal pain which increases after drinking or eating, lessens when fasting or sitting and leaning forward. Some people may not suffer pain.
[
]
* Nausea and vomiting
* Steatorrhea: Frequent, oily, foul-smelling bowel movements. Damage to the pancreas reduces the production of
pancreatic enzymes that aid digestion, which can result in malnutrition. Fats and nutrients are not absorbed properly, leading to loose, greasy stool known as
steatorrhea
Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling. An oily anal leakage or some level of fecal incontinence may o ...
.
* Weight loss even when eating habits and amounts are normal.
* Diabetes type 1: Chronic pancreatitis can affect the ability of the
pancreatic islets to produce
insulin
Insulin (, from Latin ''insula'', 'island') is a peptide hormone produced by beta cells of the pancreatic islets encoded in humans by the ''INS'' gene. It is considered to be the main anabolic hormone of the body. It regulates the metabolism ...
to regulate
glucose
Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, u ...
levels, leading to
diabetes type 1.
Symptoms of diabetes type 1 include increased hunger and thirst, frequent urination, weight loss, and fatigue.
Causes
Among the causes of chronic pancreatitis are the following:
The relationship between etiologic factors,
genetic predisposition, and the pace of disease progression requires further clarification, though recent research indicates smoking may be a high-risk factor to develop chronic pancreatitis. In a small group of patients chronic pancreatitis has been shown to be
hereditary. Almost all patients with
cystic fibrosis have established chronic pancreatitis, usually from birth. Cystic fibrosis
gene
In biology, the word gene (from , ; "...Wilhelm Johannsen coined the word gene to describe the Mendelian units of heredity..." meaning ''generation'' or ''birth'' or ''gender'') can have several different meanings. The Mendelian gene is a b ...
mutations have also been identified in patients with chronic pancreatitis but in whom there were no other manifestations of cystic fibrosis. Obstruction of the
pancreatic duct because of either a benign or malignant process may result in chronic pancreatitis.
Pathophysiology
The mechanism of chronic pancreatitis viewed from a genetic standpoint indicates early onset of severe
epigastric pain beginning in childhood. It is an
autosomal dominant disease, chronic pancreatitis disease is identified in the cationic
trypsinogen gene
PRSS1, and mutation, R122H. R122H is the most common mutation for hereditary chronic pancreatitis with replacement of
arginine
Arginine is the amino acid with the formula (H2N)(HN)CN(H)(CH2)3CH(NH2)CO2H. The molecule features a guanidino group appended to a standard amino acid framework. At physiological pH, the carboxylic acid is deprotonated (−CO2−) and both the am ...
with
histidine
Histidine (symbol His or H) is an essential amino acid that is used in the biosynthesis of proteins. It contains an α-amino group (which is in the protonated –NH3+ form under biological conditions), a carboxylic acid group (which is in the ...
at amino acid position 122 of the trypsinogen protein. There are, of course, other mechanisms – alcohol,
malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is "a deficiency, excess, or imbalance of energy, protein and other nutrients" which adversely affects the body's tissues ...
, smoking – each exhibiting its own effect on the pancreas.
Diagnosis
The diagnosis of chronic pancreatitis is based on tests on pancreatic structure and function. Serum
amylase and
lipase may be moderately elevated in cases of chronic pancreatitis. A
secretin stimulation test is considered the best test for diagnosis of chronic pancreatitis. Other tests used to determine chronic pancreatitis are
serum trypsinogen,
computed tomography,
ultrasound
Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...
and biopsy.
When chronic pancreatitis is caused by genetic factors, elevations in
ESR,
IgG4,
rheumatoid factor
Rheumatoid factor (RF) is the autoantibody that was first found in rheumatoid arthritis. It is defined as an antibody against the Fc portion of IgG and different RFs can recognize different parts of the IgG-Fc. RF and IgG join to form immune com ...
,
ANA and
anti-smooth muscle antibody may be detected.
On CT scan, pancreatic and bile duct dilatation, atrophy of pancreas, multiple calcifications of the pancreas, and enlargement of pancreatic glands can be found.
On MRI scan, there is a low T1 signal due to inflammation, fibrosis, focal lesions, and calcifications. In those who are given a contrast agent, there would be a higher T1 signal with
late gadolinium enhancement due to compression from the fibrotic areas. The overall thickness of the pancreas will be reduced. Magnetic resonance cholangiopancreatography (MRCP) is the most useful option in accessing the
pancreatic duct and
bile duct
A bile duct is any of a number of long tube-like structures that carry bile, and is present in most vertebrates.
Bile is required for the digestion of food and is secreted by the liver into passages that carry bile toward the hepatic duct. ...
.
Treatment
The different treatment options for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.
[, Available online 27 October 2005] Treatment is directed, when possible, to the underlying cause, and to relieve pain and malabsorption.
Insulin dependent diabetes mellitus
Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar for ...
may occur and need long-term insulin therapy. The abdominal pain can be very severe and require high doses of
analgesics, sometimes including
opiates. Alcohol cessation and dietary modifications (
low-fat diet) are important to manage pain and slow the calcific process.
[ Antioxidants may help but it is unclear if the benefits are meaningful.
]
Pancreatic enzymes
Pancreatic enzyme replacement is often effective in treating the malabsorption and steatorrhea
Steatorrhea (or steatorrhoea) is the presence of excess fat in feces. Stools may be bulky and difficult to flush, have a pale and oily appearance, and can be especially foul-smelling. An oily anal leakage or some level of fecal incontinence may o ...
associated with chronic pancreatitis. Treatment of CP consists of administration of a solution of pancreatic enzymes with meals. Some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis.
Surgery
Surgery to treat chronic pancreatitis tends to be divided into two areas – resectional and drainage procedures. Among the reasons to opt for surgery is if there is a pseudocyst, fistula, ascites, or a fixed obstruction.[ The Puestow procedure may be used for treatment of chronic pancreatitis.
]
Epidemiology
The annual incidence of chronic pancreatitis is 5 to 12 per 100,000 persons, the prevalence is 50 per 100,000 persons.
In 2021, Venturi reported that pancreas is able to absorb in great quantity radioactive cesium (Cs-134 and Cs-137) causing chronic pancreatitis and probably pancreatic cancer with damage of pancreatic islands with Type 3c (pancreatogenic) diabetes
Type 3c diabetes (also known as pancreatogenic diabetes) is diabetes that comes secondary to pancreatic diseases, involving the exocrine and digestive functions of the pancreas.
Around 5–10% of cases of diabetes in the Western world are related ...
.[ Text was copied from this source, which is available unde]
Creative Commons Attribution 4.0 International License
See also
* Exocrine pancreatic insufficiency
References
Further reading
*
*
*
External links
{{Medicine
Medical emergencies
Pancreas disorders
de:Pankreatitis#Chronische Pankreatitis