The pancreas is an elongate organ situated behind the stomach that produces insulin and glucagons, both hormones. The pancreas also produces chemical agents used for the digestion of food. Chronic pancreatitis is a continuous or long lasting inflammation of the pancreas.
The most obvious symptom of pancreatitis is abdominal pain. This pain is very distinctive, usually strongest in the upper abdomen, lasting for hours to even days. The pain may get worse with eating, and drinking - especially alcohol. The pain may radiate to the back and be accompanied with nausea and vomiting. Patients may also have unintended weight loss and fatty (floating) stools.
Chronic pancreatitis symptoms can be confused with pancreatic cancer.
A blood test to check for elevated levels of lipase and amylase and decreased levels of trypsinogen will help to diagnose chronic pancreatitis. Lipase and Amylase are enzymes. Trypsinogen is a precursor to the enzyme trypsin which also aides in digestion. A fecal test will determine if the stools are fatty.
Imaging of the pancreas may be used to determine if inflammation or calcium deposits are present. Imaging can be accomplished with a abdominal CT scan, abdominal ultrasound or an Endoscopic retrograde cholangiopancreatography (ERCP). The ERCP is a procedure in which a small tube (endoscope) is snaked down the throat and a catheter is guided down to the duodenum. The catheter is used to inject dye into the pancreatic ducts, which will present a visible contrast on x-rays. This procedure is commonly performed in the hospital. The patient receives a throat anesthesia spray, painkillers and sedatives for comfort. An exploratory laparotomy, a simple surgical procedure using a camera on a tube inserted into the abdomen, can also be used to confirm a pancreatitis diagnosis.
Chronic pancreatitis is most commonly caused by alcoholism or alcohol abuse. Men, more than women, are diagnosed with chronic pancreatitis, possibly because alcoholism rates are higher in the male population. Chronic pancreatitis can also be symptoms of more serious conditions, such as hyperlipidemia, hyperparathyroidism, injury, or a chronic blockage of the pancreas. Cystic Fibrosis a disease which thickens secretions in organs, in this case the pancreas. Chronic pancreatitis in children is primarily caused by cystic fibrosis. The thickened secretions in the pancreas block the ducts and affect pancreas functioning.
The pancreas becomes scared and inflamed with chronic pancreatitis, resulting in the inability to produce the correct levels of enzymes. These enzymes are used to digest fats. The scarring and inflammation also decreases or blocks insulin production - causing diabetes.
Patients with chronic pancreatitis can usually be treated by avoiding alcohol completely, managing pain, better diet and oral replacement of decreased or missing enzymes. Patients who have fatty stools are given a low fat (less than 40 grams per day) diet. Enzyme supplements are administered orally, in high doses and usually need to be taken with meals and medicines which decrease stomach acid. The supplements may reduce the pain of the patient.
Because the pain is so severe, pain management can be challenging. The risk for narcotic addiction is valid. A nerve block called a celiac plexus block can prevent pain, but only lasts at most a few months.
Surgery is recommended in some cases - especially if a block or obstruction is the cause of the chronic pancreatitis. Surgery is designed to bypass the blockage or remove it from the duct or ducts of the pancreas. Two common procedures are the Puestow procedure and the Whipple procedure. The Whipple procedure removes the top of the pancreas. The Puestow procedure, also called a pancreaticojejunostomy involves slicing the entire length of the main duct of the pancreas and directly attaching it to the small intestine. This procedure is extremely successful, with a success rate of 70 - 90 percent.
Sometimes the ducts can be dilated to remove stones or put drainage stents in place to aid the pancreas in draining into the small intestine.
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