CHRONIC PANCREATITISGerard P. Perlas,MDFPCP,FPSG,FPSDE

General ConsiderationsChronic inflammatory disease of the pancreas may present as episodes of acute inflammation in a previously injured pancreas or as chronic damage with persistent pain or malabsorption.

ETIOLOGYSimilar to acute pancreatitisIncreased incidence of cases of undetermined origin

Pathophysiology In the case of alcohol-induced pancreatitis, it has been suggested that the primary defect may be the precipitation of protein (inspissated enzymes) in the ducts. The resulting ductal obstruction could lead to duct dilation, diffuse atrophy of the acinar cells, fibrosis, and eventual calcification of some of the protein plug

Symptomatologyepigastric pain radiating through the back the pain may be worst in the right or left upper quadrant of the back or may be diffuse throughout the upper abdomen Pain is persistent, deep-seated, and unresponsive to antacids. It often is worsened by ingestion of alcohol or a heavy meal (especially one rich in fat). Often the pain is severe enough to necessitate the frequent use of narcotics.

SymptomatologyWeight lossabnormal stools, and other signs or symptoms suggestive of malabsorptionsteatorrhea

Diagnostic Testsserum amylase and lipase levels are usually not elevated in chronic pancreatitis. classic triad of pancreatic calcification, steatorrhea, and diabetes mellitus establishes the diagnosis of chronic pancreatitis and exocrine pancreatic insufficiency but is found in less than one-third of chronic pancreatitis patients.

Diagnostic TestsSecretin Test - abnormal results when 60% or more of pancreatic exocrine function has been lost. Approximately 40% of patients with chronic pancreatitis have cobalamin (vitamin B12) malabsorptionmarked excretion of fecal fat which can be reduced by the administration of oral pancreatic enzyme

Radiology

ERCP

CT SCAN