User Tools

Site Tools


pancreatitis_chronic

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.

clinical features:

  • 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:

  • 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

ED treatment:

  • exclude other diagnoses or complications
  • supportive care
  • pain relief
  • anti-emetics
  • IV fluids
  • admit of ongoing severe pain

further Ix of "idiopathic" non-alcoholic relapsing or chronic pancreatitis

  • serum calcium, phosphate
  • serum lipids
  • CT pancreas
  • US liver
  • MRI pancreas
  • +/- ERCP/MRCP
  • +/- tests to confirm presence of chronic pancreatitis
  • +/- tests to exclude genetic factors (research only?)

long term Rx:

  • advise pt to stop drinking alcohol, otherwise 5yr mortality is ~50%
  • pain control
  • relief of mechanical obstruction or complications
  • correction of malabsorption:
    • pancreatic extracts
  • NB. chronic pancreatitis increases risk of pancreatic cancer ~25 fold.
pancreatitis_chronic.txt · Last modified: 2014/10/06 09:41 (external edit)