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| {{Infobox_Disease
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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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| {{SI}}
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| ==Overview==
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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 ==
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| *[http://wikiclips.com/Chronicpancreatitis.php Video on Chronic Pancreatitis]
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| ==Symptoms==
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| 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.
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| ==Causes==
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| 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.
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| ==Diagnosis==
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| 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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| ==Treatment==
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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 3 diabetes)
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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===
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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=}}</ref>
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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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| ===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]]
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| * [[Exocrine pancreatic insufficiency]]
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| ==External links==
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| *[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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| {{SIB}}
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| {{Gastroenterology}}
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| [[Category:Gastroenterology]]
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| [[Category:Medical emergencies]]
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| [[Category:Surgery]]
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| [[Category:Emergency medicine]]
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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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