Chronic pancreatitis
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Chronic pancreatitis is an inflammatory process that leads to the progressive and irreversible destruction of exocrine and endocrine glandular pancreatic parenchyma which is substituted by fibrotic tissue,.
What causes the chronic pancreatitis?
1. Prolonged use of alcohol abuse
2. Bile duct stones
3. Drugs
4. Acute pancreatitis
5. Autoimmune
6. Parasites
7. Trauma
8. Postoperative
9. Pancreases divisum
What is the pathogenesis of chronic pancreatitis?
In earliest stages chronic pancreatitis is an acute inflammatory process and repeated episodes of sub clinic acute pancreatitis injury and necrosis lead to the fibrosis of chronic pancreatitis.
What are the sings and symptoms or chronic pancreatitis?
- Abdominal pain ? Pain can be constant or episodic and triggered by drinking alcohol.
- History of hereditary disease
- Malabsorption (steatorrhea)
- Diabetes
- Vomiting and nausea
- Loss of weight
how to diagnosed chronic pancreatitis?
Diagnosis relies on patient’s history physical examination, imaging studies and lab tests.
- Imaging studies: CT shows pancreatic calcification. Other imaging study includes ERCT, CT cholangiopancreatography.
- Lab tests: Pancreatic function test which includes:
- Stool stain fat contain
- 72-hour fat contain
- Contain of chymotrypsin, trypin and elastase in stool
What is the treatment of chronic pancreatitis?
- Complete abstinence of ethanol
- Low fat diet
- Proton pomp inhibitor plus enterically coated lipase by mouth.
- Antilipid drugs for hyperlipedmic individuals
- Steroid for autoimmune pancreatic individuals
- Pancreatic enzymes or somatostatin
- Endoscopic pancreatic sphincterotomy
- If pain is sever neuroablative procedure like celiac plexus nerve block is beneficial in some patients.
Surgical treatment in indicated in the patients in whom pain is severe enough to limit the patients lifestyle or reduce productivity and pain persists despite complete abstinence from alcohol and administration of non-narcotic analgesic.
Surgical procedure includes Whipple operation.
References:
- Sabiston textbook of surgery 18th edition
- Bailey and love ,surgery 25th edition
- www.sciencedirect.com
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