Chronic Pancreatitis
The scenario of recurrent attacks of pain and inflammation of the pancreas that last for weeks at a time is referred to as chronic pancreatitis. Here again the cause is alcoholism and it often follows an attack of acute pancreatitis. An acute pancreatitis that damages the ducts within the pancreas, leading to inflammation and scarring can lead on to chronic pancreatitis.
- A psuedo cyst that blocks the ducts also can cause chronic pancreatitis.
- Some other conditions like hypercalcemia, hyperlipidemia, cystic fibrosis and other auto immune diseases can lead to chronic pancreatitis.
- It may run in certain families when more than one member of a family may be affected. Defects in the pancreas like “pancreas divisum’ can also cause chronic pancreatitis. Rarely, even cancer of the pancreas may give rise to chronic pancreatitis.
Chronic pancreatitis in children is usually hereditary or following trauma.
Symptoms and Signs - The patient may suffer from severe pain that radiates to the back. He may also have nausea, loss of appetite and loss of weight. If a lot tissue is damaged, the lack of digestive juices leads to malabsorption, fatty stool and weight loss. Sometimes even the secretion of insulin may be affected giving rise to diabetes.
Diagnosis will require an array of tests of blood, urine and stool to assess the deficiency of the enzymes and the extent of damage.
Raised enzyme levels such as lipase are common in alcoholic chronic pancreatitis.
Urine levels of enzyme trypsin can be done to assess a case of pancreatitis that follows ERCP.
CT scans of the abdomen also help to make an accurate measure of the loss.
Endoscopic Retrograde choliangiopancreatogram can help sample the pancreatic juices and asses the level of enzymes.
Treatment of chronic pancreatitis follows the same principles as acute pancreatitis. Emphasis is placed on nutrition and pain relief. Surgery may be required to relieve pain. Enzyme containing tablets may have to be taken to improve absorption.
Diet modification in the form of a low fat-high carbohydrate meal may have to done. Diabetes will require appropriate treatment with insulin. Alcoholics must stop alcohol consumption.
