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'''Chronic [[pancreatitis]]''' is a long-standing [[inflammation]] of the [[pancreas]] that alters its normal structure and functions. It can present as episodes of acute [[inflammation]] in a previously injured [[pancreas]], or as chronic damage with persistent pain or malabsorption.


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==Symptoms==
Patients with chronic pancreatitis usually present with persistent [[abdominal pain]] or [[steatorrhea]] resulting from malabsorption of the fats in food (typically very bad-smelling and equally hard on the patient), as well as severe [[nausea]]. Diabetes is a common complication due to the chronic pancreatic damage and may require treatment with insulin. Some patients with chronic pancreatitis often look very sick, while others don't appear to be unhealthy at all.


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Considerable [[weight loss]], due to malabsorption, is evident in a high percentage of patients, and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein. some times you can aslo have pain in the heart from the fats.
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==Causes==
At least 70% of adult cases are caused by chronic alcohol use, and most patients have consumed more than 150 g/day of alcohol over six to twelve years.<ref>{{cite journal |journal=Am Fam Physician |date=2007 |volume=76 |issue=11 |pages=1679–88 |title= Chronic pancreatitis |author= Nair RJ, Lawler L, Miller MR |pmid=18092710 |url=http://www.aafp.org/afp/20071201/1679.html}}</ref> Gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and some cases of chronic pancreatitis are of undetermined or [[idiopathic]] origin. A few are inherited or secondary to [[Sphincter of Oddi]] Dysfunction (SOD). Other less frequent causes include chronic steroid and or [[anti-inflammatory]] use. In up to one quarter of cases, no cause can be found.{{Fact|date=January 2008}} Autoimmune pancreatitis is increasingly recognised and may be associated with raised IgG4 levels, other autoimmune features and bile duct involvement.


[[Cystic fibrosis]] is the most common cause of chronic pancreatitis in children. In other parts of the world, severe [[protein-energy malnutrition]] is a common cause.{{Fact|date=January 2008}}


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==Diagnosis==
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Serum [[amylase]] and [[lipase]] may well not be elevated in cases of advanced chronic pancreatitis, but are often used as markers for detecting pancreatic inflammation in acute pancreatitis. Common tests used to determine chronic pancreatitis are faecal elastase measurement in stool, Computed tomography (CT) scans, [[medical ultrasonography|ultrasounds]], EUS,, [[Magnetic resonance imaging|MRI's]] and [[Magnetic resonance cholangiopancreatography|MRCP's]]. A more invasive test called an ERCP ([[endoscopic retrograde cholangiopancreatography]]), is considered the gold standard procedure for diagnosing chronic pancreatitis but is more invasive than MRI and CT. Pancreatic [[calcification]] can often be seen on plain abdominal X-rays, as well as CT scans.
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There are other laboratory studies useful in diagnosis of chronic pancreatitis. Serum biliruin and alkaline phosphatase can be elevated, indicating stricturing of the common bile duct due to edema, fibrosis, or cancer. When the chronic pancreatitis is due to an autoimmune process, elevations in [[ESR]], [[IgG4]], [[rheumatoid factor]], [[Anti-nuclear antibody|ANA]], and antismooth muscle antibody may be seen. The common symptom of chronic pancreatits, [[steatorrhea]], can be diagnosed by two different studies: Sudan staining of feces or fecal fat excretion over 24hr on a 100g fat diet. To check for pancreatic exocrine dysfunction, the most sensitive and specific test is the measurement of fecal elastase, which can be done with a single stool sample, and a value of less than 200 ug/g indicates pancreatic insufficiency.<ref name=UpTo>{{cite web |author=Freedman SD |url=http://www.uptodate.com/patients/content/topic.do?topicKey=~EzkfCtNwumVrg |title=Clinical manifestations and diagnosis of chronic pancreatitis in adults |format= |work=UpToDate |accessdate=}}</ref>
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==Treatment==
The different treatment modalities for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.<ref name="pmid9721174">{{cite journal |author=American Gastroenterological Association Medical Position Statement |title=American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=763–4 |year=1998 |pmid=9721174 |doi=}}</ref> Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. [[Diabetes]] may occur and need long term insulin therapy. (Type 1 diabetes)


The abdominal pain can be very severe and require high doses of [[analgesic]]s. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.


===Pancreatic Enzyme Supplementation===
Replacement [[Digestive enzyme#Pancreatic enzymes|pancreatic enzymes]] are often effective in treating the malabsorption and [[steatorrhea]]. However, the outcome from 6 randomized trials has been inconclusive regarding pain reduction.<ref name="pmid9721175">{{cite journal |author=Warshaw AL, Banks PA, Fernández-Del Castillo C |title=AGA technical review: treatment of pain in chronic pancreatitis |journal=Gastroenterology |volume=115 |issue=3 |pages=765–76 |year=1998 |pmid=9721175 |doi=10.1016/S0016-5085(98)70157-X}}</ref>


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== Talk ==
While the outcome of trials regarding pain reduction with pancreatic enzyme replacement is inconclusive, some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis. Patients with alcoholic pancreatitis may be less likely to respond. <ref name=UpTo/>


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===Surgery===
Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.<ref>{{cite web |url=http://www.ngc.gov/summary/summary.aspx?ss=15&doc_id=5506 |author=Society for Surgery of the Alimentary Tract (SSAT)|year=2004||title=Operative treatment for chronic pancreatitis. |accessdate=2007-06-09 |format= |work=}}</ref>


==References==
{{reflist|2}}


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== See also ==
* [[Acute pancreatitis]]
* [[Exocrine pancreatic insufficiency]]


==External links==
*[http://videos.med.wisc.edu/videoInfo.php?videoid=247 VIDEO - Chronic Pancreatitis: Recent Advances and Ongoing Challenges], Jeffery B. Matthews, MD, speaks at the University of Wisconsin School of Medicine and Public Health (2007)


*[http://www.surgery.usc.edu/divisions/tumor/PancreasDiseases/web%20pages/PANCREATITIS/what%20is%20chronic%20pancreatit.html Medical Information and Treatment of Chronic Pancreatitis]


{{Gastroenterology}}


[[Category:Gastroenterology]]
[[Category:Medical emergencies]]
[[Category:Surgery]]



[[fr:Pancréatite chronique]]
== Instructions ==
[[it:Pancreatite cronica]]
{{Translation/Instructions|en|Opeth|Opeth}}
[[pl:Przewlekłe zapalenie trzustki]]

[[pt:Pancreatite crônica]]

[[ru:Хронический панкреатит]]

[[fi:Krooninen haimatulehdus]]
== Do not edit after here ==
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