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Monday, March 10, 2008

Chronic Pancreatitis

About Chronic Pancreatitis

Chronic pancreatitis is an ongoing inflammation of the pancreas, an organ located behind the stomach. This progressive disorder associated with the destruction of the pancreas may be confused with acute pancreatitis due to the similarities of the symptoms.

Symptoms of Chronic Pancreatitis

Upper abdominal pain and back pain with nausea and vomiting are the main symptoms of chronic pancreatitis. As the disease becomes more chronic, patients may develop malnutrition, weight loss and insulin-dependent diabetes.

The pain is usually a constant, dull pain that gets worse with eating food or drinking alcohol and lessens when sitting up and leaning forward. As the disease progresses, attacks last longer and happen more often. Attacks can last only few hours or as long as several weeks.

If a large area of the pancreas is damaged, its enzymes are not produced and can't reach the intestines. As a result, food and nutrients are poorly absorbed. Bowel movements become frequent and foul smelling because of problems with fat absorption.

If the pancreas is unable to produce the hormone insulin, these symptoms of diabetes mellitus may develop:

• increased thirst
• increased appetite
• increased urination
• fatigue
• weight loss.

If you have any of these signs with abdominal pain, see your doctor immediately.

Diagnosis of Chronic Pancreatitis

The diagnosis of chronic pancreatitis is difficult because routine blood studies (such as amylase and lipase levels) do not necessarily show elevations. The most important clue to a proper diagnosis is an accurate medical history. There are many diagnostic tests that can be used for chronic pancreatitis. The evaluation should begin with a plain film of the abdomen. The finding of pancreatic calcification is virtually diagnostic of chronic pancreatitis but quit often this is not found. Tests the doctor may use to confirm the diagnosis include:

Ultrasonography - This method uses high-frequency sound waves that are above the human audible range. An instrument sends sound waves into the patient’s abdomen, and the echoes that the sound waves produce as they bounce off internal organs creates a picture called a sonogram.

CT scanning (Computed Tomography) -This method of testing involves the use of an x-ray machine which is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.

ERCP (Endoscopic retrograde cholangiopancretography) -A method for taking x-rays of the common bile duct and the pancreatic ducts. The doctor passes a long, flexible tube called an endoscope down the throat, through the stomach, and into the small intestine. The doctor then injects dye into the ducts and takes x-rays.

EUS (Endoscopic Ultrasound) - This is a test that combines ultrasound(sound waves) with an endoscope. The doctor places the tube (endoscope) into the stomach and the ultrasound machine (which is on the endoscope) is used to direct sound waves to the pancreas.

MRI (Magnetic Resonance Imaging) - This method of testing involves the use of an x-ray machine which is linked to a computer. The patient lies on a bed that passes through a hole, and the machine moves along the patient’s body, simultaneously taking multiple x-rays. The computer then pieces the x-rays together to produce detailed pictures.

In addition to glucose tolerance test, a test to measure damage to the cells in the pancreas that make insulin and a biopsy, an exam of tissue removed from the pancreas.

Causes, incidence, and risk factors of Chronic Pancreatitis

Drinking too much alcohol is the most common cause of chronic pancreatitis. Because of the effects of chronic pancreatitis, the damaged pancreas becomes less able over time to produce normal digestive enzymes and hormones.

Chronic pancreatitis may also result from:

• excess lipids in the blood
• gallstones, which block the flow of pancreatic secretions into the intestines
• heredity, in rare cases.

The disease affects men more often than women. Alcohol abuse is an important risk factor.

Treatment of Chronic Pancreatitis

The treatment for chronic pancreatitis depends on the symptoms. However, most therapies centers focus on pain management and nutritional support. Oral pancreatic enzyme supplements are utilized to aid in the digestion of food. Patients who develop diabetes require insulin to control the blood sugar. It is important to remember that no treatment will help relieve your pain if you drink alcohol. A diet low in fat is necessary and sometimes it is easier for the patient to eat more frequently in much smaller portions. The doctor may recommend surgery to relieve abdominal pain, to restore drainage of pancreatic secretions, or to reduce the frequency of attacks.

Prognosis of Chronic Pancreatitis

As with any chronic disease, the effects may last for months or years. If you avoid alcohol completely, follow your diet, and take the medication prescribed by the doctor, your chances for improvement are good. In addition, follow the diet and take the medications the doctor prescribes to help your pancreas heal.

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