When the damaged pancreas is examined under the microscope, cells from the immune system are seen these are hard to find in the normal pancreas and the normal pancreas cells are progressively lost. Scar tissue fibrosis forms in these inflamed areas, making the pancreas harder and less regular.
In the late stages of the disease calcium is deposited in the scarred areas. The ducts tubes which transport digestive juices to the intestine also become irregular with narrowings and ballooned segments. Plugs of protein may collect in the ducts and eventually large stones may form. Cysts fluid-filled cavities are also found. Chronic pancreatitis is rare: in the UK between 6, and 12, new cases are diagnosed per year, though this is probably an underestimate.
There is no single cause of chronic pancreatitis. In most sufferers there is probably a combination of inherited genetic and environmental factors. Although smoking and heavy drinking are important risk factors for chronic pancreatitis, it is rare even in heavy smokers and drinkers. Once chronic pancreatitis is established however, it is important to give up tobacco and alcohol.
The most common genetic factor is the cystic fibrosis gene. Cystic fibrosis is the commonest cause of chronic pancreatitis in children. People with chronic pancreatitis are more likely to have a single abnormal copy of the cystic fibrosis gene than non-sufferers, but the risk of carrying a single copy is still very small.
Hereditary pancreatitis is an extremely rare genetic disease which runs in families. Autoimmune pancreatitis is also likely to have a genetic background. For the rest, it is likely that subtle variations in a number of different genes combine to make some people more susceptible to chronic pancreatitis.
The role of gallstones in chronic pancreatitis is controversial. The standard view is that gallstones are not a risk factor, but some authorities disagree. Tobacco smoking and drinking alcohol are by far the most important environmental factors.
In the UK but not the USA more men than women have chronic pancreatitis; this is thought to be because men are more likely to be heavy drinkers and smokers than women. The major symptoms of chronic pancreatitis are pain, diarrhoea and weight loss. Some patients have only one or two of these symptoms. Symptoms of diabetes may occur late in the disease. Some experts believe that many people with chronic pancreatitis have mild or no symptoms, especially in the early stages of the disease.
The pain of chronic pancreatitis is characteristically severe, felt in the upper abdomen centrally just below the ribs and may go through to the back. Some people get relief from crouching forwards. The pain may be constant or intermittent; some people also get attacks of acute pancreatitis.
The cause of pain in chronic pancreatitis is debated. Increased pressure in obstructed ducts may be a factor; there is evidence of over-growth and increased sensitivity of nerves in the pancreas itself; the brain may also become sensitised to pain signals from the pancreas forming a pain-loop.
The chronic pancreatitis suffered by people with cystic fibrosis is however generally pain-free. There may also be more generalised abdominal discomfort, nausea and bloating. A few patients with chronic pancreatitis never have pain.
Lack of enzymes due to pancreatic damage results in poor digestion and absorption of food, especially fats. Thus, weight loss is characteristic of chronic pancreatitis. Patients may notice bulky smelly bowel movements due to too much fat steatorrhea. Occasionally, an "oil slick" can be seen on the toilet water.
Swelling and scarring of the pancreas may damage other local structures. If the bile duct is narrowed, the patient may develop jaundice. Inflammation of the large vein splenic vein behind the pancreas may cause increased pressure in veins elsewhere, and the development of varices in the upper stomach and lower esophagus; these can burst and cause severe bleeding.
Patients with chronic pancreatitis carry a slightly increased risk of developing pancreatic cancer. The diagnosis of chronic pancreatitis is obvious in an advanced case with typical features: upper abdominal pains with weight loss; steatorrhea; and, diabetes. However, all of these features are seen only when the disease has been present for many years.
Most patients present with pain only. Similar pains can be caused by cancer of the pancreas although this is not usually intermittent , gallstones and bile duct stones, or severe types of gastric or duodenal ulcers. All of these conditions have to be considered and appropriate diagnostic tests applied. Endoscopic ultrasound is a technique used to detect subtle and early changes of chronic pancreatitis while ERCP is widely used in the evaluation and management of patients with known or suspected chronic pancreatitis.
Patients are normally advised to maintain a diet low in fat less than 40 gm per day when steatorrhea is present. Inflammatory bowel syndrome, which is inflammation of the digestive tract, and primary biliary cholangitis, which is a chronic liver disease associated with chronic pancreatitis.
Abusing alcohol increases your risk of developing chronic pancreatitis. Smoking is believed to increase the risk of pancreatitis among alcoholics. In some cases, a family history of chronic pancreatitis can increase your risk. Chronic pancreatitis most frequently develops in people between the ages of 30 and The condition is also more common among men than women.
Children living in tropical regions of Asia and Africa may be at risk for developing tropical pancreatitis, which is another type of chronic pancreatitis. The exact cause of tropical pancreatitis is unknown, but it may be related to malnutrition. At first, you may not notice any symptoms. Changes in your pancreas can become quite advanced before you begin to feel unwell. When symptoms occur, they may include:.
Painful episodes can last for hours or even days. Some people find that eating or drinking can make their pain worse. As the disease progresses, the pain may become constant. During the early stages of chronic pancreatitis, changes in your pancreas are difficult to see in blood tests. However, they may be used to determine the amount of pancreatic enzymes in your blood.
Blood tests may also be used to check blood cell counts along with kidney and liver function. Your doctor might ask you for a stool sample to test for levels of fat. Imaging tests are the most reliable way for your doctor to make a diagnosis.
Your doctor might request that the following studies be done on your abdomen to look for signs of inflammation:. Your doctor may also recommend an endoscopic ultrasound. During an endoscopic ultrasound, your doctor inserts a long, flexible tube into your mouth and down through the stomach and small intestine. The tube contains an ultrasound probe, which emits sound waves that create detailed images of your pancreas.
Treatment for chronic pancreatitis focuses on reducing your pain and improving your digestive function. Treatment for pancreatitis can include medication, endoscopic therapies, or surgery. Email address. First Name let us know your preferred name. Last Name. Thank you for subscribing Your in-depth digestive health guide will be in your inbox shortly. Sorry something went wrong with your subscription Please, try again in a couple of minutes Retry. Request an Appointment at Mayo Clinic. Share on: Facebook Twitter.
Show references Pancreatitis. Accessed Aug. Pancreatitis: Acute and chronic. American College of Gastroenterology. Feldman M, et al. Elsevier; Richardson A, et al.
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