Chronic Pancreatitis

Guest Poster:  Chronic pancreatitis  by Dr. Josh Stripling

 Definition: Irreversible destruction of the pancreatic parenchyma causing varying degrees of endocrine and exocrine dysfunction

  •  most patients typically present with persistent abdominal pain and steatorrhea
  • exocrine dysfunction – chronic diarrhea and weight loss
  • approx 20% present with maldigestion without pain

Causes:

  • The most common cause of chronic pancreatitis is alcohol use (usually more than 10y and more than 50g/day)
  • TIGAR-O (Toxic-metabolic, Idiopathic, Genetic, Autoimmune, Recurrent and severe acute pancreatitis, Obstructive)
  • tobacco also increase the risk of developing chronic pancreatitis

Diagnosis:  there are two specific entities: large- duct and small-duct (minimal change)

  • no consensus on gold standard for diagnosis: difficult testing and not always available
  • typical diagnosis is clinical based on symptoms and imaging
  • available testing includes: Secretin and CCK stimulation tests, fecal elastase, serum tripsinogen, stool sudan stain
  • most patients should undergo MRCP (not ERCP) or EUS to evaluate pancreatic ducts
  • patients can progress to development of pancreatic cancer

Plain film or CT can highlight pancreatic calcification to support the diagnosis

Management

  • avoidance of cause: EtOH cessation, pancreatic duct stenting, etc.
  • enteric coated pancreatic enzyme supplementation (40,000 units of lipase recommended) plus acid suppressant
  • fat-soluble vitamin replacement
  • monitor for endocrine dysfunction
  • pain management is difficult and theoretical improvement in pain with enzyme supplementation may occur
  • total pancreatectomy with islet cell transplantation is becoming more frequent

Resources: MKSAP 16, Harrison’s, “Chronic Pancreatitis” AFP 2007

Images: Medscape, http://www.meddean.luc.edu, healthcentral.com, drug3K.com

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s