Written by Chin Ming Huay
Last Reviewed: April 2019
Review Due: April 2020
'recurrent episodes of inflammation of the pancreas, leading to structural damage and loss of function'
Longstanding alcohol excess is the most common cause.
Recurrent acute pancreatitis
Obstruction of pancreatic duct
Trypsinogen and inhibitory protein deficits
SIGNS AND SYMPTOMS
Radiation: Radiates to the back
Exacerbating factors: Worse after eating
Relieving factors: Sitting forwards
Other associated signs and symptoms
Weight loss and malnutrition
The common pathway for chronic pancreatitis is an increase in activated trypsin within the pancreas. Over a long period of time, plugs form within the duct lumen due to precipitation of proteins. These plugs can become calcified and may also lead to ductal obstruction which exacerbates damage to the pancreas.
Histologically, there is loss of pancreatic acini which are replaced by fibrosis, leading to reduced secretion of pancreatic enzymes. The islets of Langerhans may be damaged, leading to diabetes mellitus.
If raised, may be sign of pancreatic endocrine insufficiency
Diagnose chronic pancreatitis, look for pancreatic calcifications and changes to ductal structure
It is important to treat the effects of chronic pancreatitis such as pain and pancreatic insufficiency, and it is also important to treat the underlying cause if possible.
May add opiate analgesia according to the WHO pain ladder
Coeliac axis nerve block
Managing Pancreatic Insufficiency
Pancreatic enzyme supplements
Improves steatorrhoea and malabsorption symptoms
Given with a protein pump inhibitor (e.g., omeprazole) or H2 receptor antagonist (e.g., ranitidine) to prevent acid degradation of enzyme supplements in the stomach
Stabilises blood glucose control
Treating the underlying cause
Alcohol – Counselling, referral to addiction services if required, vitamin replacement
Autoimmune – Steroids
Incidence in the UK is estimated to be 5 to 12 cases per 100,000 people, and the prevalence is 50 per 100,000 people.
Increased risk of pancreatic cancer