CHRONIC PANCREATITIS

Chronic pancreatitis is a disease of the pancreas in which recurrent episodes of inflammation lead to replacement of
the pancreatic parenchyma with fibrotic connective tissue, formation of calculous and loss of duct architecture. This
leads to progressive loss of pancreas function.

Causes

  • Toxic/metabolic: alcohol, tobacco, hypercalcemia, hyperlipidemia, chronic renal failure
  • Idiopathic: tropical
  • Genetic, autoimmune
  • Recurrent and severe acute pancreatitis
  • Obstructive cancer or anatomical abnormalities

Clinical features

  • Chronic pain: main symptom in chronic pancreatitis
  • Diarrhoea
  • Loss of weight
  • Diabetes mellitus

Complications of chronic pancreatitis

  • Pseudocysts
  • Stenosis of the pancreatic duct
  • Duodenal stenosis
  • Vascular complications
  • Compression of the bile ducts
  • Malnutrition
  • Increased risk of cancer of the pancreas

Investigations

  • Blood: Serum analysis, complete blood count, random blood sugar
  • Raised pancreatic amylase/lipase > 3 times normal
  • Ultrasound: gallstones, pancreatic oedema, abdominal fluid
  • Liver function tests: raised liver enzymes

Management

Chronic pancreatitis requires specialized management,

  • Refer for specialist management
  • Use WHO Pain Analgesic ladder
    • Pethidine 50-100 mg IM or Tramadol 50-100 mg oral or IM as required
  • Avoid alcohol and fatty foods