Chronic pancreatitis

Definition

Chronic pancreatitis is swelling (inflammation) of the pancreas that leads to scarring and loss of function. The pancreas is an organ located behind the stomach that produces chemicals needed to digest food. It also produces the hormones insulin and glucagon.

Causes, incidence, and risk factors

Chronic pancreatitis causes inflammation and scarring of tissue in the pancreas. This makes the pancreas unable to produce the right amount of chemicals (enzymes) needed to digest fat. It also interferes with insulin production, which may lead to diabetes.

The condition is most often caused by alcoholism and alcohol abuse. Sometimes the cause cannot be determined, however. Genetic causes have become more common. Other conditions have also been linked to chronic pancreatitis, such as:

• Chronic blockage of the pancreatic duct
• Injury
• Hyperlipidemia
• Hyperparathyroidism

Chronic pancreatitis occurs more frequently in men than in women. This may be because alcohol-use disorders are more common in men.

Symptoms

• Abdominal pain
  • Greatest in the upper abdomen
  • May last from hours to days
  • Eventually may be continuous
  • May be worsened by eating or drinking
  • May be worsened by drinking alcohol
  • May spread (radiate) to the back
• Digestive problems
• Fatty stools
• Nausea and vomiting
• Pale or clay-colored stools
• Unintentional weight loss

The symptoms may become more frequent as the condition gets worse. The symptoms may mimic pancreatic cancer. Sitting up and leaning forward may sometimes relieve the abdominal pain of pancreatitis.

Signs and tests

Tests for pancreatitis include:

• Fecal fat test
• Serum amylase
• Serum lipase
• Serum trypsinogen

Inflammation or calcium deposits of the pancreas may be seen on:

• Abdominal CT scan
• Abdominal ultrasound
• ERCP

An exploratory laparotomy may be done to confirm the diagnosis of pancreatitis.

Treatment

The goal of treatment is to:

• Prevent indigestion
• Reduce pain
• Reduce stimulation of the pancreas
• Treat diabetes (if present)

Treatment may involve:

• Analgesics or surgical nerve block to relieve pain
• Eating a low-fat diet
• Getting enough vitamins and calcium in the diet
• Taking insulin to control blood sugar (glucose) levels
• Taking pancreatic enzyme supplements

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

Expectations (prognosis)

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

Complications

• 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
  • Diabetes
  • Fat malabsorption

Calling your health care provider

Call for an appointment with your health care provider if:

• You develop symptoms of pancreatitis
• You have pancreatitis and your symptoms worsen or do not improve with treatment

Prevention

Determining the cause of acute pancreatitis and treating it promptly may help to prevent chronic pancreatitis. Avoiding heavy consumption of alcohol dramatically reduces the risk of developing this condition.

References

Nair RJ, Lawler L, Miller MR. Chronic pancreatitis. Am Fam Physician. 2007;76:1679-1688.