CHRONIC PANCREATITIS : DEFINITION , CAUSES , CLINICAL FEATURES , TREATMENT & COMPLICATIONS

DEFINITION :

Diffuse inflammatory process of pancreas involving head , body ,& the tail resulting in permanent structural &  functional damage to the pancreas .

CAUSES :

1. Alcohol : Alcohol stimulates the pancreatic secretion rich protein .This form plugs in the pancreatic duct & resulting in stasis of secretion & stone formation .
2.Nutritional : Common in kerala & was thought to be due to consumption of tapioca .It is called kerala pancreatitis .
3.Hereditary pancreatitis : It is genetic disorder transmitted in mendelian -dominant trait.
4.Cystic fibrosis :Generalised dysfunction of exocrine glands because of which secretion precipitate in the lumen .
5.Hyperparathyroidism favours precipitation of calcium intraductally .

CLINICAL FEATURES :

1.Malabsorption occurs due to damage to exocrine glands resulting in steatorrhoea 10-15 stools per day  ,bulky ,frothy ,rich in fat ,foul smelling .
2.Obstructive jaundice can occurs due to oedema of the head of the pancreas .
3.Pain in upper abdomen radiating to the back in the region of L1 , L2 due to retroperitoneal inflammation .
4.Exploratory laparotomy -Many cases are diagnosed at laparotomy - irregularity ,hardness involving in the entire pancreas .
5.Diabetes -Incidence of diabetes is about 10-20%.

Conservative treatment :

Pain relief by analgesics , supplement pancreatic enzyme , diet should be low in fat , vitamin D supplements should be given , control of diabetes & stop alcohol .
Indications of surgery :
Persistent pain ,obstructive jaundice & duodenal obstructions .

COMPLICATIONS :

Obstructive jaundice due to mass lesion in the head region  , carcinoma of pancreases , pseudocysts .