A B C D E F G H I J K L M N O P R S T U V W

PANCREATITIS : CHRONIC

What is Chronic Pancreatitis ?

The pancreas (sweetbread) is a gland that is situated in the back of the upper abdominal cavity. The gland has two main functions. The first is to produce an enzyme that helps digest certain types of food in the gut, particularly fats. The second is to produce the hormone insulin that controls the level of glucose in the body cells. Chronic inflammation of the pancreas gland often produces pain in the upper abdomen and back. This may persist for hours or days. It results from the swelling of the gland. Because food is poorly digested, fat is present in large amounts in the stools, making them pale, smelly, and bulky. This loss of fat means a loss of weight, too. The shortage of insulin allows the sugar in the blood to rise, causing excessive thirst, passing of large amounts of urine, and even more weight loss (insulin-dependent diabetes or non-insulin-dependent diabetes).

How does Chronic Pancreatitis occur ?

In Europe the commonest cause of pancreatitis is alcohol. When drunk in large amounts, alcohol damages the pancreas by inflaming it. Gallstones are the other main cause. They may block the exit duct from the pancreas which in turn creates inflammation. Rarely, a high blood fat or calcium level produces this disorder. Inflammation of the gland causes damage to the ducts inside the gland. Protein plugs block the ducts and prevent the enzymes from leaving the pancreas. These enzymes can then cause damage to the pancreas by causing more inflammation. Scar tissue then forms and eventually leads to a small, hard pancreas which does not function properly.

Why does Chronic Pancreatitis occur ?

It is not known why only some people with alcohol or gallstone problems get this condition. There may be a hereditary factor.

Treatment Involved for Chronic Pancreatitis

Usually tests are needed to confirm the diagnosis. Occasionally a simple X-ray of the abdomen may reveal an abnormal pancreas. Special scans such as ultrasound or CT scan are used to demonstrate the size of the gland. MRI scans [Magnetic Resonance Imaging] scans are beginning to be used as well. The aim of these scans is to obtain as much information as possible about the pancreas without any risk attached to the test. Sometimes it may be necessary to perform an ERCP [endoscopic retrograde cholangiopancreatography] which is a telescope test that allows a special dye to be injected directly into the pancreas. Once chronic pancreatitis has developed it is important to avoid all alcohol to try and limit further damage. If there is a rare cause such as raised fat levels or high calcium levels then these are treated. Dietary restrictions and treatment for diabetes may also be required as damage becomes more severe. Pain killing tablets are sometimes needed and artificial pancreatic enzymes can be added to food. For a minority of patients an operation to remove part of the pancreas may be needed.

During Treatment for Chronic Pancreatitis

Complete abstinence from alcohol reduces the risk of an attack of pancreatitis and the development of other complications. Pain can usually be well controlled. Weight loss and diarrhoea improve with pancreatic enzyme supplements. Narcotic pain-relieving drugs such as codeine can cause constipation. The doctor should be contacted if pain is severe and not controlled by pain-relieving drugs, and if weight loss despite treatment.

After Treatment for Chronic Pancreatitis

Further attacks of pain are always a reason to contact the doctor. A change of treatment may be required. The onset of diabetes may develop some years after the onset of chronic pancreatitis. Excessive thirst, frequent passing of urine and skin infections are the hints that this condition has developed.

If Chronic Pancreatitis is Left Untreated

There would be more recurrent episodes of abdominal pain, weight loss due to poor absorption of food and eventually symptoms of diabetes. Finally, the resistance of the body would be so low that severe infection could occur, occasionally with fatal consequences.

Effects on Family of Chronic Pancreatitis

Chronic pancreatitis can be a very distressing condition. Pain can be severe and sympathetic support from family and friends can be helpful. In addition, if alcohol has caused the condition it is important that all the family are aware that lifelong abstinence is required.