Chronic pancreatitis history and symptoms: Difference between revisions
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== M-ANNHEIM clinical staging of Chronic pancreatitis == | |||
{| class="wikitable" | |||
!Chronic pancreatitis | |||
!Stage | |||
! | |||
|- | |||
| rowspan="4" |Asymptomatic | |||
|0 | |||
|Stage of subclinical chronic pancreatitis | |||
|- | |||
|a | |||
|Period without symptoms (determination by chance, e.g., autopsy) | |||
|- | |||
|b | |||
|Acute pancreatitis—single episode (possible onset of chronic pancreatitis) | |||
|- | |||
|c | |||
|Acute pancreatitis with severe complications | |||
|- | |||
| rowspan="14" |Symptomatic | |||
|I | |||
|Stage without pancreatic insufficiency | |||
|- | |||
|a | |||
|(Recurrent) acute pancreatitis (no pain between episodes of acute pancreatitis) | |||
|- | |||
|b | |||
|Recurrent or chronic abdominal pain (including pain between episodes of acute pancreatitis) | |||
|- | |||
|c | |||
|I a/b with severe complications | |||
|- | |||
|II | |||
|Stage of partial pancreatic insufficiency | |||
|- | |||
|a | |||
|Isolated exocrine (or endocrine) pancreatic insufficiency (without pain) | |||
|- | |||
|b | |||
|Isolated exocrine (or endocrine) pancreatic insufficiency (with pain) | |||
|- | |||
|c | |||
|II a/b with severe complications | |||
|- | |||
|III | |||
|Stage of painful complete pancreatic insufficiency | |||
|- | |||
|a | |||
|Exocrine and endocrine insufficiency (with pain, e.g., requiring pain medication) | |||
|- | |||
|b | |||
|III a with severe complications | |||
|- | |||
|IV | |||
|Stage of secondary painless disease (burnout) | |||
|- | |||
|a | |||
|Exocrine and endocrine insufficiency without pain and without severe complications | |||
|- | |||
|b | |||
|Exocrine and endocrine insufficiency without pain and with severe complications | |||
|} | |||
== M-ANNHEIM scoring system for the grading of clinical features of chronic pancreatitis == | == M-ANNHEIM scoring system for the grading of clinical features of chronic pancreatitis == |
Revision as of 20:06, 17 November 2017
Chronic pancreatitis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
History and Symptoms
- Presentation depends upon dysfunction in any one of the following:
- Biliary tract obstruction; presenting as jaundice
- Exocrine dysfunction; presenting as malabsorption
- Endocrine dysfunction; presenting as diabetes
Patients with chronic pancreatitis usually present with:
- Persistent abdominal pain with episodic flares may or may not be associated with food intake[1][2][3][4]. Typical features of pain are:
- Located in the epigastrium
- Radiating to the back
- May be associated with nausea and vomiting
- Usually worse 15-30min after meal
- Initially it occurs in discrete episodes but later on as the disease progresses, it changes to continuous-like pattern
- Steatorrhea resulting from malabsorption of the fats in food (greasy, loose, very bad smelling stools that are difficult to flush away).[5][6][7]
- Pancreatic diabetes[5][8][6]
- Nausea
- Weight loss
M-ANNHEIM clinical staging of Chronic pancreatitis
Chronic pancreatitis | Stage | |
---|---|---|
Asymptomatic | 0 | Stage of subclinical chronic pancreatitis |
a | Period without symptoms (determination by chance, e.g., autopsy) | |
b | Acute pancreatitis—single episode (possible onset of chronic pancreatitis) | |
c | Acute pancreatitis with severe complications | |
Symptomatic | I | Stage without pancreatic insufficiency |
a | (Recurrent) acute pancreatitis (no pain between episodes of acute pancreatitis) | |
b | Recurrent or chronic abdominal pain (including pain between episodes of acute pancreatitis) | |
c | I a/b with severe complications | |
II | Stage of partial pancreatic insufficiency | |
a | Isolated exocrine (or endocrine) pancreatic insufficiency (without pain) | |
b | Isolated exocrine (or endocrine) pancreatic insufficiency (with pain) | |
c | II a/b with severe complications | |
III | Stage of painful complete pancreatic insufficiency | |
a | Exocrine and endocrine insufficiency (with pain, e.g., requiring pain medication) | |
b | III a with severe complications | |
IV | Stage of secondary painless disease (burnout) | |
a | Exocrine and endocrine insufficiency without pain and without severe complications | |
b | Exocrine and endocrine insufficiency without pain and with severe complications |
M-ANNHEIM scoring system for the grading of clinical features of chronic pancreatitis
Clinical feature | Score | |
---|---|---|
Pain | No pain without therapy | 0 |
Recurrent acute pancreatitis | 1 | |
No pain with therapy | 2 | |
Intermittent pain | 3 | |
Continuous pain | 4 | |
Pain control | No medication | 0 |
Use of nonopioid drugs or use of mild opioids (WHO step 1 or 2) | 1 | |
Use of potent opioids (WHO step 3) or endoscopic intervention | 2 | |
Surgical intervention | Pancreatic surgical intervention for any reason | 4 |
Exocrine insufficiency | Absence of exocrine insufficiency | 0 |
Presence of mild, moderate, or unproven exocrine insufficiency not requiring enzyme supplementation (including patient reports of intermittent diarrhea) | 1 | |
Presence of proven exocrine insufficiency (according to exocrine function tests) or presence of marked exocrine insufficiency defined as steatorrhea (>7 g fat/24 h), normalized or markedly reduced by enzyme supplementation | 2 | |
Endocrine insufficiency | Absence of diabetes mellitus | 0 |
Presence of diabetes mellitus | 4 | |
Morphologic status on pancreatic imaging (according to the Cambridge classification) | Normal | 0 |
Equivocal | 1 | |
Mild | 2 | |
Moderate | 3 | |
Marked | 4 | |
Severe organ complications | Absence of complications | 0 |
Presence of possibly reversible complications | 2 | |
Presence of irreversible complications | 4 |
M-ANNHEIM severity index of chronic pancreatitis:
Severity index | Severity level | Point range |
---|---|---|
M-ANNHEIM A | Minor | 0–5 points |
M-ANNHEIM B | Increased | 6–10 points |
M-ANNHEIM C | Advanced | 11–15 points |
M-ANNHEIM D | Marked | 16–20 points |
M-ANNHEIM E | Exacerbated | >20 points |
References
- ↑ Ammann RW, Akovbiantz A, Largiader F, Schueler G (1984). "Course and outcome of chronic pancreatitis. Longitudinal study of a mixed medical-surgical series of 245 patients". Gastroenterology. 86 (5 Pt 1): 820–8. PMID 6706066.
- ↑ Lankisch PG, Seidensticker F, Löhr-Happe A, Otto J, Creutzfeldt W (1995). "The course of pain is the same in alcohol- and nonalcohol-induced chronic pancreatitis". Pancreas. 10 (4): 338–41. PMID 7792289.
- ↑ Warshaw AL (1984). "Pain in chronic pancreatitis. Patients, patience, and the impatient surgeon". Gastroenterology. 86 (5 Pt 1): 987–9. PMID 6706079.
- ↑ Layer P, Yamamoto H, Kalthoff L, Clain JE, Bakken LJ, DiMagno EP (1994). "The different courses of early- and late-onset idiopathic and alcoholic chronic pancreatitis". Gastroenterology. 107 (5): 1481–7. PMID 7926511.
- ↑ 5.0 5.1 DiMagno EP, Go VL, Summerskill WH (1973). "Relations between pancreatic enzyme outputs and malabsorption in severe pancreatic insufficiency". N. Engl. J. Med. 288 (16): 813–5. doi:10.1056/NEJM197304192881603. PMID 4693931.
- ↑ 6.0 6.1 Mergener K, Baillie J (1997). "Chronic pancreatitis". Lancet. 350 (9088): 1379–85. doi:10.1016/S0140-6736(97)07332-7. PMID 9365465.
- ↑ Toskes PP, Hansell J, Cerda J, Deren JJ (1971). "Vitamin B 12 malabsorption in chronic pancreatic insufficiency". N. Engl. J. Med. 284 (12): 627–32. doi:10.1056/NEJM197103252841202. PMID 5547614.
- ↑ Malka D, Hammel P, Sauvanet A, Rufat P, O'Toole D, Bardet P, Belghiti J, Bernades P, Ruszniewski P, Lévy P (2000). "Risk factors for diabetes mellitus in chronic pancreatitis". Gastroenterology. 119 (5): 1324–32. PMID 11054391.