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Accessed July 22, 2012.
- Progressive disease characterized by long-standing pancreatic
inflammation that eventually leads to loss of pancreatic exocrine
and endocrine function.
- 70–80% of cases due to chronic alcohol
- 20% of cases idiopathic.
- 10% of cases due to rare causes, for example:
- Tropical pancreatitis
- Long-standing pancreatic inflammation leads to destruction
of pancreatic tissue with fibrin deposition with loss of exocrine
and endocrine function.
- Abdominal pain may be caused by increased pancreatic parenchymal
pressure from obstruction, inflammation, and necrosis.
- Malabsorption of protein and fat occurs when capacity for
enzyme secretion reduced by 90%.
- Complications may include pancreatic pseudocyst, abscess,
and ascites or common bile duct obstruction leading to cholangitis
or secondary biliary cirrhosis.
- Occurs in 6 per 100,000 population, with peak incidence
between ages 35 and 54.
- About 85% of cases occur in men.
- Prevalence varies widely basedon geographic location.
- Avoidance of known risk factors.
- Increased or excessive alcohol consumption
- Cigarette smoking
- High fat and protein diet
- Hereditary or familial pancreatitis
- Possible gene mutations
- Pancreatic duct obstruction
- Chronic kidney disease
- Deep, penetrating epigastric or abdominal pain that may
radiate to the back.
- Pain often occurs with meals and at night, and may be associated
with nausea and vomiting.
- Steatorrhea, azotorrhea, diarrhea, bloating, and weight loss
- Pancreatic diabetes a late manifestation associated with pancreatic
- Jaundice occurs in ~10% of patients.
Means of Confirmation
- Clinical presentation and imaging or pancreatic function
- Serum amylase and lipase usually normal or only slightly
elevated but may be increased in acute exacerbations.
- Total bilirubin, alkaline phosphatase, and hepatic transaminases
may be elevated with ductal obstruction.
- Serum albumin and calcium may be low with malnutrition.
- Pancreatic function tests include:
- Serum trypsinogen
(<20 ng/mL abnormal)
- Fecal elastase (<200 mcg/g of stool abnormal)
- 72-hour fecal fat estimation (>7 g/day abnormal)
- Secretin stimulation (evaluates duodenal bicarbonate secretion)
- 13C-mixed triglyceride breath test
- Abdominal ultrasound
- Computed tomography (CT)
- Magnetic resonance cholangiopancreatography (MRCP)
- Endoscopic ultrasonography (EUS)
- Endoscopic retrograde cholangiopancreatography (ERCP)
- Histology generally not recommended.
- Relieve abdominal pain.
- Treat complications of malabsorption and glucose intolerance.
- Improve quality of life.
- Abstinence from alcohol and smoking cessation
- Smaller, more frequent meals and reduced dietary fat intake
to reduce steatorrhea
- Consider whole protein or peptide-based oral nutritional supplements
for patients who do not consume adequate dietary calories.
- Consider invasive procedures and surgery for uncontrolled
pain and complications.
- Initial pain management with nonopioid analgesics (e.g.,
acetaminophen, nonsteroidal anti-inflammatory drugs [NSAIDs])
given on ...