Chronic Pancreatitis

What is Pancreatitis?

Pancreatitis is actually swelling in the pancreas, which is a big gland behind the stomach and close to the duodenum – the first part of the small intestine. The pancreas release digestive enzymes through a tube called the pancreatic duct into the duodenum, where these enzymes mix with bile to digest food. The pancreas also releases the insulin and glucagon hormones into the bloodstream, which help the body, control the glucose it takes from food for energy. Usually, digestive enzymes produced by the pancreas do not get dynamic until they reach the small intestine. But when the pancreas is sore, these enzymes attack from the inside and harm the same tissues that create them. Pancreatitis can either be acute or chronic and in either state, it is serious and can lead to difficulties. In extreme cases, the patient will experience infection, bleeding, and permanent damage in the tissues. Men are known to suffer from both kinds of pancreatitis more than women.

Pancreatic Cancer

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How does Chronic Pancreatitis differ from Acute Pancreatitis?

Unlike acute pancreatitis, which tends to be painful, chronic pancreatitis may be asymptomatic for a long time. The pancreatic enzyme levels in the blood tend to be normal in chronic pancreatitis, whereas they are elevated in the acute condition.

What Causes Chronic Pancreatitis?

  • Alcohol abuse
  • Genetic causes
  • Obstruction of the pancreatic duct (stones, tumors, trauma)
  • Autoimmune pancreatitis
  • Cigarette smoking
  • Unidentifiable cause (Idiopathic)

Signs or Symptoms of Chronic Pancreatitis

  • Abdominal pain that radiates to the back, occurs soon after meals and is better by sitting up or leaning forward.
  • Fat malabsorption resulting in loose, greasy stools, foul smelling stools. The pancreas secretes enzymes that are responsible for digestion of fat and in chronic pancreatitis, this can be affected.
  • Diabetes because of destruction of pancreatic cells by the chronic inflammation.

How can Chronic Pancreatitis be Diagnosed?

The diagnosis can be challenging, especially since a lot of signs and symptoms of pancreatitis may not be present in the chronic condition and may not occur until very late in the disease.

  • Lab Studies

    Measuring pancreatic enzymes, full blood counts, liver function tests and presence of inflammatory markers could be helpful, but are usually normal.

  • Fecal Elastase

    Measuring the quantity of elastase in the patient’s stool samples can be a good way of catching chronic pancreatitis early.

  • Imaging

    Looking for calcifications on an X ray, or using CT, MRI, ERCP and ultrasound can reveal the morphological abnormalities seen in chronic pancreatitis.

  • Pancreatic Function Tests

    These tests try to stimulate the pancreas and then analyze the contents of intestinal fluid to look at whether the pancreas is able to provide the required enzymes for digestion.

  • Genetic Testing

    Diseases like cystic fibrosis and hereditary pancreatitis are linked with specific mutations that can increase the patient’s chances of developing chronic pancreatitis in his or her lifetime.

What other Diseases can be Confused with Chronic Pancreatitis?

The signs and symptoms of chronic pancreatitis may overlap with other diseases of the gastro intestinal tract. The major diagnosis that needs to be ruled out is pancreatic cancer, but the symptoms could also be due to gallstones, peptic ulcer disease, irritable bowel syndrome and of course, acute pancreatitis.

What are the Complications of Chronic Pancreatitis?

Some of the more common complications of chronic pancreatitis involve pseudocyst formation and obstruction of the common bile duct. Pseudocysts are formed due to mechanical destruction of the pancreas and can get infected. Bile duct obstruction can cause jaundice if severe and symptoms after meals. Liver function may be affected.

 

Pancreas

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Pancreas Duodenum

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  • If the patient develops diabetes mellitus, insulin supplementation may need to be done. Other hypoglycemic agents can be tried, although diabetes because of chronic pancreatitis usually requires the patient to be put on insulin therapy.

 

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