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| | __NOTOC__ |
| {{Infobox_Disease | | {{Infobox_Disease |
| | Name = {{PAGENAME}} | | | Name = Chronic pancreatitis |
| | Image = Chronic-pancreatitis-006.jpg | | | Image = Blausen 0699 PancreasAnatomy2.png |
| | Caption = Chronic pancreatitis. <br> [http://www.radswiki.net Image courtesy of RadsWiki] | | | Caption = Pancreas<ref><https://en.wikipedia.org/wiki/Pancreas#/media/File:Blausen_0699_PancreasAnatomy2.png></ref> |
| | DiseasesDB = 9559
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| | ICD10 = {{ICD10|K|86|0|k|80}}-{{ICD10|K|86|1|k|80}}
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| | ICD9 = {{ICD9|577.1}}
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| | ICDO =
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| | OMIM = 167800
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| | MedlinePlus = 000221
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| | eMedicineSubj = med
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| | eMedicineTopic = 1721
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| | MeshID = D050500
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| }} | | }} |
| {{SI}} | | {{Chronic pancreatitis}} |
| {{CMG}}
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| {{Editor Help}} | | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| ==Overview==
| | '''For full discussion on Pancreatitis click [[Pancreatitis|here]].''' |
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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.
| | {{CMG}}, {{AE}}: {{IQ}} |
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| ==Causes==
| | {{SK}} Pancreatitis, chronic; |
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| 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.
| | ==[[Chronic pancreatitis overview|Overview]]== |
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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 historical perspective|Historical Perspective]]== |
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| ==Symptoms== | | ==[[Chronic pancreatitis classification|Classification]]== |
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| 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.
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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 pathophysiology|Pathophysiology]]== |
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| ==Diagnosis== | | ==[[Chronic pancreatitis causes|Causes]]== |
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| 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.
| | ==[[Chronic pancreatitis differential diagnosis|Differentiating Chronic pancreatitis from other Diseases]]== |
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| 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]].
| | ==[[Chronic pancreatitis epidemiology and demographics|Epidemiology and Demographics]]== |
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| ==Diagnostic Findings== | | ==[[Chronic pancreatitis risk factors|Risk Factors]]== |
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| ===Computed Tomography=== | | ==[[Chronic pancreatitis screening|Screening]]== |
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| * Dilatation of the main pancreatic duct
| | ==[[Chronic pancreatitis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| * Calcifications
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| * Changes in pancreatic size, shape, and contour
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| * [[Pancreatic pseudocyst]]s
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| ===='''Patient #1'''==== | | ==Diagnosis== |
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| [http://www.radswiki.net Images courtesy of RadsWiki] | | [[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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| <gallery perRow="3">
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| Image:Chronic-pancreatitis-001.jpg
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| Image:Chronic-pancreatitis-002.jpg
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| Image:Chronic-pancreatitis-003.jpg
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| Image:Chronic-pancreatitis-004.jpg
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| Image:Chronic-pancreatitis-005.jpg
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| Image:Chronic-pancreatitis-006.jpg
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| </gallery>
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| ===='''Patient #2'''====
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| MR and CT demonstrate superior mesenteric vein thrombosis secondary to chronic pancreatitis:
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| [http://www.radswiki.net Images courtesy of RadsWiki] | |
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| <gallery perRow="3">
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| Image:Superior-mesenteric-vein-thrombosis-001.jpg
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| Image:Superior-mesenteric-vein-thrombosis-002.jpg
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| Image:Superior-mesenteric-vein-thrombosis-005.jpg
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| Image:Superior-mesenteric-vein-thrombosis-006.jpg
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| Image:Superior-mesenteric-vein-thrombosis-007.jpg
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| Image:Superior-mesenteric-vein-thrombosis-008.jpg
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| Image:Superior-mesenteric-vein-thrombosis-009.jpg
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| Image:Superior-mesenteric-vein-thrombosis-010.jpg
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| </gallery>
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| ==Treatment== | | ==Treatment== |
| | [[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 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 1 diabetes)
| | ==Case Studies== |
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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.
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| ===Pancreatic Enzyme Supplementation===
| | [[Chronic pancreatitis case study one|Case #1]] |
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| 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=10.1016/S0016-5085(98)70157-X}}</ref>
| | == Related Chapters == |
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| 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. <ref name=UpTo/>
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| ===Surgery===
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| 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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| ==References==
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| {{Reflist|2}}
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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}} |
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| * [http://goldminer.arrs.org/search.php?query=chronic%20pancreatitis Goldminer: Chronic pancreatitis]
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| * [http://videos.med.wisc.edu/videoInfo.php?videoid=247 VIDEO - Chronic Pancreatitis: Recent Advances and Ongoing Challenges]
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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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| {{SIB}}
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| [[Category:Gastroenterology]] | | [[Category:Gastroenterology]] |
| [[Category:Medical emergencies]]
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| [[Category:Surgery]] | | [[Category:Surgery]] |
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