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| {{CMG}} | | __NOTOC__ |
| | {{Infobox_Disease |
| | | Name = Chronic pancreatitis |
| | | Image = Blausen 0699 PancreasAnatomy2.png |
| | | Caption = Pancreas<ref><https://en.wikipedia.org/wiki/Pancreas#/media/File:Blausen_0699_PancreasAnatomy2.png></ref> |
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| | {{Chronic pancreatitis}} |
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| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| | '''For full discussion on Pancreatitis click [[Pancreatitis|here]].''' |
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| | {{CMG}}, {{AE}}: {{IQ}} |
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| | {{SK}} Pancreatitis, chronic; |
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| | ==[[Chronic pancreatitis overview|Overview]]== |
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| ==Overview== | | ==[[Chronic pancreatitis historical perspective|Historical Perspective]]== |
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| | ==[[Chronic pancreatitis classification|Classification]]== |
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| | ==[[Chronic pancreatitis pathophysiology|Pathophysiology]]== |
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| | ICD10 = {{ICD10|K|86|0|k|80}}-{{ICD10|K|86|1|k|80}}
| | ==[[Chronic pancreatitis causes|Causes]]== |
| | ICD9 = {{ICD9|577.1}}
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| '''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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| ==Video on Chronic Pancreatitis == | | ==[[Chronic pancreatitis differential diagnosis|Differentiating Chronic pancreatitis from other Diseases]]== |
| *[http://wikiclips.com/Chronicpancreatitis.php Video on Chronic Pancreatitis]
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| ==Symptoms== | | ==[[Chronic pancreatitis epidemiology and demographics|Epidemiology and Demographics]]== |
| Patients with chronic pancreatitis can present with persistent [[abdominal pain]] or [[steatorrhea]] ([[diarrhea]] resulting from malabsorption of the fats in food, typically very bad-smelling and equally hard on the patient), as well as severe [[nausea]]. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.
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| 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.
| | ==[[Chronic pancreatitis risk factors|Risk Factors]]== |
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| ==Causes== | | ==[[Chronic pancreatitis screening|Screening]]== |
| The most common cause in the Western world of chronic pancreatitis is excess alcohol ingestion. 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 autoimmune in nature or secondary to Sphincter of Oddi Dysfunction (SOD). Other less frequent causes include chronic steroid and or anti-inflammitory use. In up to one quarter of cases, no cause can be found.
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| [[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. | | ==[[Chronic pancreatitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| 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 undiagnosed patients. Common tests used to determine chronic pancreatitis are serum amylase and serum lipase blood tests, [[triglyceride]] blood tests, enzyme measurement in stool, [[X-ray]]s, [[medical ultrasonography|ultrasounds]], EUS, [[Computed tomography|CT scans]], [[Magnetic resonance imaging|MRI's]] and [[Magnetic resonance cholangiopancreatography|MRCP's]]. A more invasive test called an ERCP ([[endoscopic retrograde cholangiopancreatography]]), is considered the gold standard procedure for diagnosing chronic pancreatitis. Pancreatic [[calcification]] can often be seen on 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== | | ==Treatment== |
| The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.<ref name="pmid9721174">{{cite journal |author=American Gastroenterological Association Medical Position Statement |title=American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=763-4 |year=1998 |pmid=9721174 |doi=}}</ref> 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 3 diabetes)
| | [[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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| The abdominal pain can be very severe and require high doses of [[analgesic]]s. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.
| | ==Case Studies== |
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| ===Pancreatic Enzyme Supplementation===
| | [[Chronic pancreatitis case study one|Case #1]] |
| Replacement [[Digestive enzyme#Pancreatic enzymes|pancreatic enzymes]] are often effective in treating the malabsorption and [[steatorrhea]]. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.<ref name="pmid9721175">{{cite journal |author=Warshaw AL, Banks PA, Fernández-Del Castillo C |title=AGA technical review: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=765-76 |year=1998 |pmid=9721175 |doi=}}</ref>
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| ===Surgery=== | | == Related Chapters == |
| Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.<ref>{{cite web |url=http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=5506 |author=Society for Surgery of the Alimentary Tract (SSAT)|year=2004||title=Operative treatment for chronic pancreatitis. |accessdate=2007-06-09 |format= |work=}}</ref>
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| ===Therapeutic Endoscopy===
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| Endoscopic drainage of the pancreatic duct is less successful than surgical drainage and does not shorten the hospital stay.<ref name="pmid17301298">{{cite journal |author=Cahen DL, Gouma DJ, Nio Y, ''et al'' |title=Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis |journal=N. Engl. J. Med. |volume=356 |issue=7 |pages=676-84 |year=2007 |pmid=17301298 |doi=10.1056/NEJMoa060610}}</ref><ref name="pmid12822088">{{cite journal |author=Díte P, Ruzicka M, Zboril V, Novotný I |title=A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis |journal=Endoscopy |volume=35 |issue=7 |pages=553-8 |year=2003 |pmid=12822088 |doi=10.1055/s-2003-40237}}</ref>
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| ==References==
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| <references/>
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| == See also ==
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| * [[Acute pancreatitis]] | | * [[Acute pancreatitis]] |
| * [[Exocrine pancreatic insufficiency]] | | * [[Exocrine pancreatic insufficiency]] |
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| ==External links==
| | {{Gastroenterology}} |
| *[http://videos.med.wisc.edu/videoInfo.php?videoid=247 VIDEO - Chronic Pancreatitis: Recent Advances and Ongoing Challenges], Jeffery B. Matthews, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)
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| *[http://www.surgery.usc.edu/divisions/tumor/PancreasDiseases/web%20pages/PANCREATITIS/what%20is%20chronic%20pancreatit.html Medical Information and Treatment of Chronic Pancreatitis]
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| {{Gastroenterology}}
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Medical emergencies]]
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| [[Category:Surgery]] | | [[Category:Surgery]] |
| [[Category:Emergency medicine]]
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| | [[fr:Pancréatite chronique]] |
| | [[it:Pancreatite cronica]] |
| | [[pl:Przewlekłe zapalenie trzustki]] |
| [[pt:Pancreatite crônica]] | | [[pt:Pancreatite crônica]] |
| [[ru:Хронический панкреатит]] | | [[ru:Хронический панкреатит]] |
| [[fi:Krooninen haimatulehdus]] | | [[fi:Krooninen haimatulehdus]] |
| | [[tr:Kronik pankreatit]] |
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