Difference between revisions of "Chronic pancreatitis"

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{{Infobox_Disease
 
{{Infobox_Disease
  | Name          = {{PAGENAME}}
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  | Name          = Chronic pancreatitis
  | Image          =  
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  | Image          = Blausen 0699 PancreasAnatomy2.png
  | Caption        =  
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  | Caption        = Pancreas<ref><https://en.wikipedia.org/wiki/Pancreas#/media/File:Blausen_0699_PancreasAnatomy2.png></ref>
| DiseasesDB    = 9559
 
| ICD10          = {{ICD10|K|86|0|k|80}}-{{ICD10|K|86|1|k|80}}
 
| ICD9          = {{ICD9|577.1}}
 
| ICDO          =
 
| OMIM          = 167800
 
| MedlinePlus    = 000221
 
| eMedicineSubj  = med
 
| eMedicineTopic = 1721
 
| MeshID        = D050500
 
 
}}
 
}}
{{SI}}
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{{Chronic pancreatitis}}
{{CMG}}
 
  
{{Editor Help}}
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'''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
  
==Overview==
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'''For full discussion on Pancreatitis click [[Pancreatitis|here]].'''
  
'''Chronic [[pancreatitis]]''' is a long-standing [[inflammation]] of the [[pancreas]] that alters its normal structure and functions. It can present as episodes of acute [[inflammation]] in a previously injured [[pancreas]], or as chronic damage with persistent pain or malabsorption.
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{{CMG}}, {{AE}}: {{IQ}}
  
==Causes==
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{{SK}} Pancreatitis, chronic;
  
At least 70% of adult cases are caused by chronic alcohol use, and most patients have consumed more than 150 g/day of alcohol over six to twelve years.<ref>{{cite journal |journal=Am Fam Physician |date=2007 |volume=76 |issue=11 |pages=1679–88 |title= Chronic pancreatitis |author= Nair RJ, Lawler L, Miller MR |pmid=18092710 |url=http://www.aafp.org/afp/20071201/1679.html}}</ref> Gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and some cases of chronic pancreatitis are of undetermined or [[idiopathic]] origin. A few are inherited or secondary to Sphincter of Oddi dysfunction (SOD).  Other less frequent causes include chronic steroid and or [[anti-inflammatory]] use. In up to one quarter of cases, no cause can be found. Autoimmune pancreatitis is increasingly recognized and may be associated with raised IgG4 levels, other autoimmune features and bile duct involvement.
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==[[Chronic pancreatitis overview|Overview]]==
  
[[Cystic fibrosis]] is the most common cause of chronic pancreatitis in children. In other parts of the world, severe [[protein-energy malnutrition]] is a common cause.
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==[[Chronic pancreatitis historical perspective|Historical Perspective]]==
  
==Symptoms==
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==[[Chronic pancreatitis classification|Classification]]==
 
Patients with chronic pancreatitis usually present with persistent [[abdominal pain]] or [[steatorrhea]] resulting from malabsorption of the fats in food (typically very bad-smelling and equally hard on the patient), as well as severe [[nausea]]. Diabetes is a common complication due to the chronic pancreatic damage and may require treatment with insulin. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.
 
  
Considerable [[weight loss]], due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein.
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==[[Chronic pancreatitis pathophysiology|Pathophysiology]]==
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==[[Chronic pancreatitis causes|Causes]]==
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==[[Chronic pancreatitis differential diagnosis|Differentiating Chronic pancreatitis from other Diseases]]==
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==[[Chronic pancreatitis epidemiology and demographics|Epidemiology and Demographics]]==
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==[[Chronic pancreatitis risk factors|Risk Factors]]==
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==[[Chronic pancreatitis screening|Screening]]==
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==[[Chronic pancreatitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
  
 
==Diagnosis==
 
==Diagnosis==
  
The diagnosis of chronic pancreatitis is typically based on tests on pancreatic structure and function, as direct biopsy of the pancreas is considered excessively risky. Serum [[amylase]] and [[lipase]] may well not be elevated in cases of advanced chronic pancreatitis, but are often used as markers for detecting pancreatic inflammation in acute pancreatitis. A '''[[secretin]] stimulation test''' is considered the gold standard functional test for diagnosis of chronic pancreatitis. The observation that bi-carbonate production is impaired early in chronic pancreatitis has led to the rationale of use of this test in early stages of disease ([[sensitivity]] of 95%). Other common tests used to determine chronic pancreatitis are faecal elastase measurement in stool, serum trypsinogen, Computed tomography (CT) scans, [[medical ultrasonography|ultrasounds]], EUS, [[Magnetic resonance imaging|MRI's]], [[ERCP]] and [[Magnetic resonance cholangiopancreatography|MRCP's]]. Pancreatic [[calcification]] can often be seen on plain abdominal X-rays, as well as CT scans.
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[[Chronic pancreatitis diagnostic study of choice|Diagnostic Study of Choice]] | [[Chronic pancreatitis history and symptoms|History and Symptoms ]] | [[ Chronic pancreatitis physical examination|Physical Examination]] | [[Chronic pancreatitis laboratory findings|Laboratory Findings]] | [[Chronic pancreatitis abdominal x ray|Abdominal X Ray]] | [[Chronic pancreatitis CT|CT]] | [[Chronic pancreatitis MRI|MRI]] | [[Chronic pancreatitis ultrasound|Ultrasound]] | [[Chronic pancreatitis other imaging findings|Other Imaging Findings]] | [[Chronic pancreatitis other diagnostic studies|Other Diagnostic Studies]]
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==Treatment==
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[[Chronic pancreatitis medical therapy|Medical Therapy]] | [[Chronic pancreatitis surgery |Surgery]] | [[Chronic pancreatitis primary prevention|Primary Prevention]] | [[Chronic pancreatitis secondary prevention|Secondary Prevention]] | [[Chronic pancreatitis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] [[Chronic pancreatitis future or investigational therapies|Future or Investigational Therapies]]
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==Case Studies==
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[[Chronic pancreatitis case study one|Case #1]]
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== Related Chapters ==
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* [[Acute pancreatitis]]
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* [[Exocrine pancreatic insufficiency]]
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{{Gastroenterology}}
  
There are other non-specific laboratory studies useful in diagnosis of chronic pancreatitis. Serum bilirubin and alkaline phosphatase can be elevated, indicating stricturing  of the common bile duct due to edema, fibrosis or cancer.  When the chronic pancreatitis is due to an autoimmune process, elevations in [[ESR]], IgG4, [[rheumatoid factor]], [[Anti-nuclear antibody|ANA]] and antismooth muscle antibody may be seen.  The common symptom of chronic pancreatits, [[steatorrhea]], can be diagnosed by two different studies: Sudden staining of feces or fecal fat excretion over 24hr on a 100g fat diet.  To check for pancreatic exocrine dysfunction, the most sensitive and specific test is the measurement of fecal elastase, which can be done with a single stool sample, and a value of less than 200 ug/g indicates pancreatic insufficiency.<ref name=UpTo>{{cite web |author=Freedman SD |url=http://www.uptodate.com/patients/content/topic.do?topicKey=~EzkfCtNwumVrg |title=Clinical manifestations and diagnosis of chronic pancreatitis in adults |format= |work=UpToDate  |accessdate=}}</ref>[[abdominal pain]].
 
  
==References==
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[[Category:Gastroenterology]]
{{Reflist|2}}
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[[Category:Surgery]]
  
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[[fr:Pancréatite chronique]]
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[[it:Pancreatite cronica]]
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[[pl:Przewlekłe zapalenie trzustki]]
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[[pt:Pancreatite crônica]]
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[[ru:Хронический панкреатит]]
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[[fi:Krooninen haimatulehdus]]
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[[tr:Kronik pankreatit]]
  
  

Latest revision as of 16:03, 15 December 2017

Chronic pancreatitis
Blausen 0699 PancreasAnatomy2.png
Pancreas[1]

Chronic pancreatitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic pancreatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

American Pancreatic Association Practice Guidelines

APA Clinical Practice Guidelines for Chronic pancreatiits

Chronic pancreatitis On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Chronic pancreatitis

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X-rays
Echo & Ultrasound
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MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic pancreatitis

CDC on Chronic pancreatitis

Chronic pancreatitis in the news

Blogs on Chronic pancreatitis

Directions to Hospitals Treating Chronic pancreatitis

Risk calculators and risk factors for Chronic pancreatitis

For patient information click here

For full discussion on Pancreatitis click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Associate Editor(s)-in-Chief: : Iqra Qamar M.D.[2]

Synonyms and Keywords: Pancreatitis, chronic;

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic pancreatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice | History and Symptoms | Physical Examination | Laboratory Findings | Abdominal X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Medical Therapy | Surgery | Primary Prevention | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

it:Pancreatite cronica fi:Krooninen haimatulehdus




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