CHRONIC

PRANCREATITIS
Ø An inflammatory disorder characterized by progressive
anatomic and functional destruction of the pancreas.

ETIOLOGY
ü Alcohol consumption and malnutrition CAUSES
·Alcohol abuse
are the major causes of chronic
·Obstruction caused by
pancreatitis.
cholelithiasis (gallstone)
ü Long-term alcohol consumption causes
·Tumor
hypersecretion of protein in pancreatic
·Psuedocyst
secretions, resulting in protein plugs and
·Trauma
calculi within the pancreatic ducts.
·Systematic disease (systematic
ü Alcohol also has a direct toxic effect
lupus erythematosus)
on the cells of the pancreas. Damage to
·Autoimmune pancreatitis
these cells is more likely to occur and to
·Cystic fibrosis
be more severe in patients whose diets

are poor in protein content and either

very high or very low in fat.

MANIFES
L TATIO
LINICA NS
C
>Characterized by recurring attacks of severe upper abdominal and back pain, accompanied
by vomiting.
> Attacks are often so painful that opioids, even in large doses, do not provide relief.
> Some patients experience continuous severe pain; others have a dull, nagging constant pain.
> Weight loss usually caused by decreased dietary intake secondary to anorexia or fear that
eating will precipitate another attack.
> Malabsorption occurs late in the disease, when as little as 10% of pancreatic function
remains. As a result, digestion, especially of proteins and fats, is impaired.
> Steatorrhea
> Calcification of the gland may occur, and calcium
stones may form within the ducts.
 pathophysiology

Ø As cells are replaced by fibrous tissue with repeated attacks of

pancreatitis, pressure within the pancreas increases.
Ø Result to mechanical obstruction of the pancreatic and common bile
ducts and the duodenum.
Ø There will be a atrophy of the epithelium of the ducts
Ø Inflammation
Ø Destruction of the secreting cells of the pancreas.

ASSESSMENT AND DIAGNOSTIC MEDICAL MANAGEMENT

FINDINGS >Treatment is directed toward
>ERCP is the most useful study in preventing and managing acute
the diagnosis of chronic attacks, relieving pain and
pancreatitis. discomfort, and managing
> Magnetic resonance imaging exocrine and endocrine
insufficiency of pancreatitis.
>Computed tomography
>Ultrasound
> Glucose tolerance test evaluates
pancreatic islet cell function
> Serum amylase levels and white
blood cell count may not be
elevated

NONSURGICAL MANAGEMENT
>Endoscopy to remove pancreatic duct stones and stent strictures may be
effective in selected patients to manage pain and relieve obstruction.
>Management of abdominal pain and discomfort is similar to acute pancreatitis;
however, the focus is usually on the use of nonopioid methods to manage pain.
> Emphasize to the patient and family the importance of avoiding alcohol and
other foods that the patient has found tend to produce abdominal pain and
discomfort.
SURGICAL MANAGEMENT
1.Pancreaticojejunostomy (also referred to as Roux-en-Y)
with a side-to-side anastomosis or joining of the pancreatic duct
to the jejunum allows drainage of the pancreatic secretions into
the jejunum. Pain relief occurs by 6 months in more than 80%
of the patients who undergo this procedure, but pain returns in
a substantial number of patients as the disease itself
progresses.
2.Whipple resection (pancreaticoduodenectomy) has been
carried out to relieve the pain of chronic pancreatitis.
Autotransplantation or implantation of the patient’s pancreatic
islet cells has been attempted to preserve the endocrine
function
of the pancreas in patients who have undergone total
pancreatectomy. Testing and refinement of this procedure
continue in an effort to improve outcomes.