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Chronic pancreatitis

Chronic pancreatitis is inflammation of the pancreas that does not heal or improve, gets worse over time, and leads to permanent damage.

Causes

The pancreas is an organ located behind the stomach that produces chemicals (called enzymes) needed to digest food. It also produces the hormones insulin and glucagon.

When inflammation and scarring of the pancreas occur, the organ is no longer able to make the right amount of these enzymes. As a result, your body may be unable to digest fat and key elements of food.

Damage to the parts of the pancreas that make insulin may lead to diabetes.

The condition is most often caused by alcohol abuse over many years. Repeated episodes of acute pancreatitis can lead to chronic pancreatitis. Genetics may be a factor in some cases. Sometimes, the cause is not known.

Other conditions that have been linked to chronic pancreatitis:

  • Autoimmune problems (when the immune system attacks the body)
  • Blockage of the pancreatic duct or the common bile duct, the tubes that drain enzymes from the pancreas
  • Complications of cystic fibrosis
  • High levels of a fat, called triglycerides, in the blood (hypertriglyceridemia)
  • Use of certain medications (especially sulfonamides, thiazides, and azathioprine)

Chronic pancreatitis occurs more often in men than in women. The condition often develops in people ages 30 - 40.

Symptoms

Abdominal pain :

  • Greatest in the upper abdomen
  • May last from hours to days
  • Eventually may be continuous
  • May get worse from eating or drinking
  • May get worse from drinking alcohol
  • May also be felt in the back

Digestive problems:

  • Chronic weight loss, even when eating habits and amounts are normal
  • Diarrhea, nausea, and vomiting
  • Fatty or oily stools
  • Pale or clay-colored stools

You may need an exploratory laparotomy may be done to confirm the diagnosis. This is more often done for acute pancreatitis.

Exams and Tests

Tests for pancreatitis include:

Inflammation or calcium deposits of the pancreas, or changes to the ducts of the pancreas may be seen on:

An exploratory laparotomy may be done to confirm the diagnosis, but this is usually done for acute pancreatitis.

Treatment

People with severe pain or who are losing weight may need to stay in the hospital for:

  • Pain medicines
  • Fluids given through a vein (IV)
  • Stopping food or fluid by mouth to limit the activity of the pancreas, and then slowly starting an oral diet
  • Inserting a tube through the nose or mouth to remove the contents of the stomach (nasogastric suctioning ) may sometimes be done. The tube may stay in for 1 - 2 days, or sometimes for 1 - 2 weeks.

The right diet is important for people with chronic pancreatitis to keep a healthy weight and get the correct nutrients. A nutritionist can help you create a diet that includes:

  • Drinking plenty of liquids
  • Limiting fats
  • Eating small, frequent meals (this helps reduce digestive symptoms)
  • Getting enough vitamins and calcium in the diet, or as extra supplements
  • Limiting caffeine

The doctor may prescribe pancreatic enzymes. You must take these medicines with every meal. The enzymes will help you digest food better and gain weight.

Avoid smoking and drinking alcoholic beverages, even if your pancreatitis is mild.

Other treatments may involve:

  • Pain medicines or a surgical nerve block to relieve pain
  • Taking insulin to control blood sugar (glucose) levels

Surgery may be recommended if a blockage is found. In severe cases, part or all of the pancreas may be removed.

Outlook (Prognosis)

This is a serious disease that may lead to disability and death. You can reduce the risk by avoiding alcohol.

Possible Complications

Complications may include:

  • Ascites
  • Blockage (obstruction) of the small intestine or bile ducts
  • Blood clot in the vein of the spleen
  • Fluid collections in the pancreas (pancreatic pseudocysts ) that may become infected
  • Poor function of the pancreas, including diabetes, fat or other nutrient malabsorption ,¬†and vitamin malabsorption (most often the fat-soluble vitamins, A, D, E, or K)

When to Contact a Medical Professional

Call your health care provider if:

  • You develop symptoms of pancreatitis
  • You have pancreatitis, and your symptoms get worse or do not improve with treatment

Prevention

Determining the cause of acute pancreatitis and treating it quickly may help prevent chronic pancreatitis. Limiting the amount of alcohol you drink can reduce your risk of getting this condition.

References

Forsmark CE. Pancreatitis. In: Goldman L, Shafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 46.

Updated: 2/10/2014

Todd Eisner, MD, Private practice specializing in Gastroenterology, Boca Raton, FL. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.


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