Difference between revisions of "Chronic pancreatitis"

Jump to: navigation, search
(Patient #1)
(Diagnostic Findings)
Line 63: Line 63:
  
 
===='''Patient #2'''====  
 
===='''Patient #2'''====  
 +
 +
MR and CT demonstrate [[superior mesenteric vein thrombosis]] secondary to chronic pancreatitis:
  
 
<gallery>
 
<gallery>

Revision as of 23:46, 15 March 2009

Chronic pancreatitis
ICD-10 K86.0-K86.1
ICD-9 577.1
OMIM 167800
DiseasesDB 9559
MedlinePlus 000221
eMedicine med/1721 
MeSH D050500

WikiDoc Resources for Chronic pancreatitis

Articles

Most recent articles on Chronic pancreatitis

Most cited articles on Chronic pancreatitis

Review articles on Chronic pancreatitis

Articles on Chronic pancreatitis in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Chronic pancreatitis

Images of Chronic pancreatitis

Photos of Chronic pancreatitis

Podcasts & MP3s on Chronic pancreatitis

Videos on Chronic pancreatitis

Evidence Based Medicine

Cochrane Collaboration on Chronic pancreatitis

Bandolier on Chronic pancreatitis

TRIP on Chronic pancreatitis

Clinical Trials

Ongoing Trials on Chronic pancreatitis at Clinical Trials.gov

Trial results on Chronic pancreatitis

Clinical Trials on Chronic pancreatitis at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Chronic pancreatitis

NICE Guidance on Chronic pancreatitis

NHS PRODIGY Guidance

FDA on Chronic pancreatitis

CDC on Chronic pancreatitis

Books

Books on Chronic pancreatitis

News

Chronic pancreatitis in the news

Be alerted to news on Chronic pancreatitis

News trends on Chronic pancreatitis

Commentary

Blogs on Chronic pancreatitis

Definitions

Definitions of Chronic pancreatitis

Patient Resources / Community

Patient resources on Chronic pancreatitis

Discussion groups on Chronic pancreatitis

Patient Handouts on Chronic pancreatitis

Directions to Hospitals Treating Chronic pancreatitis

Risk calculators and risk factors for Chronic pancreatitis

Healthcare Provider Resources

Symptoms of Chronic pancreatitis

Causes & Risk Factors for Chronic pancreatitis

Diagnostic studies for Chronic pancreatitis

Treatment of Chronic pancreatitis

Continuing Medical Education (CME)

CME Programs on Chronic pancreatitis

International

Chronic pancreatitis en Espanol

Chronic pancreatitis en Francais

Business

Chronic pancreatitis in the Marketplace

Patents on Chronic pancreatitis

Experimental / Informatics

List of terms related to Chronic pancreatitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.

Overview

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.

Causes

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.[1] 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.

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.

Symptoms

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.

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, ultrasounds, EUS, MRI's, ERCP and MRCP's. Pancreatic calcification can often be seen on plain abdominal X-rays, as well as CT scans.

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, 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.[2]abdominal pain.

Diagnostic Findings

Computed Tomography

  • Dilatation of the main pancreatic duct
  • Calcifications
  • Changes in pancreatic size, shape, and contour
  • Pancreatic pseudocysts

Patient #1

Images courtesy of RadsWiki

Patient #2

MR and CT demonstrate superior mesenteric vein thrombosis secondary to chronic pancreatitis:

Treatment

The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.[3] Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Diabetes may occur and need long term insulin therapy. (Type 1 diabetes)

The abdominal pain can be very severe and require high doses of analgesics. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.

Pancreatic Enzyme Supplementation

Replacement pancreatic enzymes are often effective in treating the malabsorption and steatorrhea. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.[4]

While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis. Patients with alcoholic pancreatitis may be less likely to respond. [2]

Surgery

Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.[5]

References

  1. Nair RJ, Lawler L, Miller MR (2007). "Chronic pancreatitis". Am Fam Physician. 76 (11): 1679–88. PMID 18092710.
  2. 2.0 2.1 Freedman SD. "Clinical manifestations and diagnosis of chronic pancreatitis in adults". UpToDate.
  3. American Gastroenterological Association Medical Position Statement (1998). "American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis". Gastroenterology. 115 (3): 763–4. PMID 9721174.
  4. Warshaw AL, Banks PA, Fernández-Del Castillo C (1998). "AGA technical review: treatment of pain in chronic pancreatitis". Gastroenterology. 115 (3): 765–76. doi:10.1016/S0016-5085(98)70157-X. PMID 9721175.
  5. Society for Surgery of the Alimentary Tract (SSAT) (2004). "Operative treatment for chronic pancreatitis". Retrieved 2007-06-09.

See also

External links


Cost Effectiveness of Chronic pancreatitis

| group5 = Clinical Trials Involving Chronic pancreatitis | list5 = Ongoing Trials on Chronic pancreatitis at Clinical Trials.govTrial results on Chronic pancreatitisClinical Trials on Chronic pancreatitis at Google


| group6 = Guidelines / Policies / Government Resources (FDA/CDC) Regarding Chronic pancreatitis | list6 = US National Guidelines Clearinghouse on Chronic pancreatitisNICE Guidance on Chronic pancreatitisNHS PRODIGY GuidanceFDA on Chronic pancreatitisCDC on Chronic pancreatitis


| group7 = Textbook Information on Chronic pancreatitis | list7 = Books and Textbook Information on Chronic pancreatitis


| group8 = Pharmacology Resources on Chronic pancreatitis | list8 = AND (Dose)}} Dosing of Chronic pancreatitisAND (drug interactions)}} Drug interactions with Chronic pancreatitisAND (side effects)}} Side effects of Chronic pancreatitisAND (Allergy)}} Allergic reactions to Chronic pancreatitisAND (overdose)}} Overdose information on Chronic pancreatitisAND (carcinogenicity)}} Carcinogenicity information on Chronic pancreatitisAND (pregnancy)}} Chronic pancreatitis in pregnancyAND (pharmacokinetics)}} Pharmacokinetics of Chronic pancreatitis


| group9 = Genetics, Pharmacogenomics, and Proteinomics of Chronic pancreatitis | list9 = AND (pharmacogenomics)}} Genetics of Chronic pancreatitisAND (pharmacogenomics)}} Pharmacogenomics of Chronic pancreatitisAND (proteomics)}} Proteomics of Chronic pancreatitis


| group10 = Newstories on Chronic pancreatitis | list10 = Chronic pancreatitis in the newsBe alerted to news on Chronic pancreatitisNews trends on Chronic pancreatitis


| group11 = Commentary on Chronic pancreatitis | list11 = Blogs on Chronic pancreatitis

| group12 = Patient Resources on Chronic pancreatitis | list12 = Patient resources on Chronic pancreatitisDiscussion groups on Chronic pancreatitisPatient Handouts on Chronic pancreatitisDirections to Hospitals Treating Chronic pancreatitisRisk calculators and risk factors for Chronic pancreatitis


| group13 = Healthcare Provider Resources on Chronic pancreatitis | list13 = Symptoms of Chronic pancreatitisCauses & Risk Factors for Chronic pancreatitisDiagnostic studies for Chronic pancreatitisTreatment of Chronic pancreatitis

| group14 = Continuing Medical Education (CME) Programs on Chronic pancreatitis | list14 = CME Programs on Chronic pancreatitis

| group15 = International Resources on Chronic pancreatitis | list15 = Chronic pancreatitis en EspanolChronic pancreatitis en Francais

| group16 = Business Resources on Chronic pancreatitis | list16 = Chronic pancreatitis in the MarketplacePatents on Chronic pancreatitis

| group17 = Informatics Resources on Chronic pancreatitis | list17 = List of terms related to Chronic pancreatitis


}} it:Pancreatite cronica fi:Krooninen haimatulehdus





Linked-in.jpg