chronic pancreatitis

epidemiology:

70-80% of cases are due to alcohol abuse, most of the remaining are idiopathic
other causes:
- malnutrition
- hyperPTH
- cystic fibrosis
- trauma
- hereditary pancreatitis
- pancreas divisum
- ampullary stenosis
mean age of onset 42yrs, mean age of death 52yrs
prevalence is 0.04 to 5% as often undiagnosed
more common in males
gallstones are NOT a cause of chronic pancreatitis as acute pancreatitis does not progress to chronic disease unless complications such as pseudocysts or ductal strictures are present.

90% have pain - usually mid-epigastric & may radiate to back
abdominal tenderness often less prominent
nausea & vomiting may be present
in early stages, discrete attacks of pain lasting days to weeks occur (“relapsing pancreatitis”)
pain is often worse after alcohol ingestion or a fatty meal
as disease progresses, pain-free periods become less frequent and disappear completely
unlike acute pancreatitis, pts appear chronically ill & may have signs of pancreatic insufficiency including LOW, steatorrhoea, clubbing & polyuria.
stigmata of chronic liver disease may also be present if cause is alcohol abuse

diagnosis is often difficult
amylase & lipase levels are usually normal although may be raised & offer no prognostic assistance
glucose tolerance is often impaired
5-10% have compression of intrahepatic portion of the bile duct leading to elevated bilirubin & AP
AXR - pancreatic calcification is said to be pathognomic & is present in 30%, esp. those with alcohol-induced disease