Definition  

The pancreas is a long, flat, pear-shaped organ located behind the stomach. It makes digestive enzymes and hormones, including insulin. Chronic pancreatitis is a progressive inflammation of the pancreas marked by frequent acute attacks and risk of permanent organ damage.

Pancreatitis  
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Causes  

Chronic pancreatitis results from prolonged injury, toxic exposure, autoimmune disease, or obstruction of the pancreas.

Risk Factors  

Chronic pancreatitis is more common in men. Other factors that may increase your risk of chronic pancreatitis include:

Personal health history, such as:

Conditions that obstruct the passageway from the pancreas to the small intestine include:

  • Trauma
  • Tumors
  • Pseudocysts—build up of fluids and debris

Chronic pancreatitis is a risk factor for developing pancreatic cancer.

Symptoms  

Symptoms may be mild, but progressive. Chronic pancreatitis may cause:

  • Abdominal pain that: may get worse when eating or drinking, spreading to the back, or become constant and disabling
    • Spreads to the back
    • Gets worse when eating or drinking
    • Becomes constant or disabling
  • Nausea and vomiting
  • Weight loss
  • Diarrhea—with presence of excess fat or nitrogen-based substances in the stool
Diagnosis  

Your doctor will ask about your symptoms and medical history. A physical exam will be done. The diagnosis of chronic pancreatitis is difficult. Symptoms are not specific early on in the course of the disease.

Tests may include

  • Blood tests—to look for elevated levels the digestive enzymes or other conditions
  • Stool tests

Imaging tests can be used to evaluate the pancreas nearby structures. Imaging tests include:

Treatment  

The goals of treatment for chronic pancreatitis are to relieve pain and manage nutritional and metabolic problems.

Treatment may be started in a hospital until you are stabilized. Stabilization can be done with:

  • IV fluids
  • Nasogastric tube—A long, thin tube is threaded through your nose and into your stomach for feeding.
Medications  

Your doctor may recommend:

  • Prescription pain relievers
  • Pancreatic enzymes
  • Vitamin supplements
  • Medications to control diabetes if it develops
Lifestyle Changes  

Your doctor will advise you to stop drinking alcohol. This may require counseling or a rehabilitation program. Stopping your alcohol intake is the most important intervention in your treatment.

If you smoke, talk to your doctor about how you can successfully quit.

Your doctor may also suggest that you restrict the amount of fat in your diet. Pancreatic damage interferes with the body's ability to process fats. A registered dietitian can work with you and create a healthy meal plan.

Surgery  

Surgery may be needed in severe cases:

  • Necrosectomy—Removal of dying or dead (necrotic) pancreatic tissue. Pancreatic necrosis is more serious if an infection is present. This procedure can also be done with endoscopy.
  • ECRP—To open any collapsed ducts or drain cysts.
  • Cholecystectomy—To remove the gallbladder.
Prevention  

Aside from avoiding too much alcohol, there are no current guidelines to prevent chronic pancreatitis. If you have recurrent attacks or are at high risk for developing chronic pancreatitis, you can make other lifestyle changes that may reduce your risk.