Chronic pancreatitis: Difference between revisions
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==Background==
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==Background== <!--T:1-->
 
<!--T:2-->
[[File:Blausen 0699 PancreasAnatomy2.png|thumb|Pancreatic anatomy]]
*Chronic imflammatory changes of the pancreas causing permanent structural damage
*Chronic imflammatory changes of the pancreas causing permanent structural damage
*Can be minimally symptomatic and presents with acute exacerbations.
*Can be minimally symptomatic and presents with acute exacerbations.
*Can lead to both long term endocrine and exocrine dysfunction
*Can lead to both long term endocrine and exocrine dysfunction


==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref><ref>Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206</ref>==
 
*Pain
==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref><ref>Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206</ref>== <!--T:3-->
 
<!--T:4-->
*[[Special:MyLanguage/Abdominal pain|Pain]]
**Episodic (1wk) or constant
**Episodic (1wk) or constant
**Epigastric, radiating to back and left infrascapular region
**Epigastric, radiating to back and left infrascapular region
**Associated with nausea/vomiting
**Associated with nausea/vomiting
**Improved with sitting up or leaning forward
**Improved with sitting up or leaning forward
*Steatorrhea/DM
*Steatorrhea/[[Special:MyLanguage/DM|DM]]
**Late finding
**Late finding
**Requires >80-90% loss of exocrine and endocrine function
**Requires >80-90% loss of exocrine and endocrine function
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**Hyperpigmentation of upper abdomen
**Hyperpigmentation of upper abdomen


==Differential Diagnosis==
 
==Differential Diagnosis== <!--T:5-->
 
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{{Abdominal Pain DDX Epigastric}}
{{Abdominal Pain DDX Epigastric}}
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==Evaluation== <!--T:6-->


==Evaluation==
<!--T:7-->
*Labs
*Labs
**Lipase: Normal or slightly elevated
**Lipase: Normal or slightly elevated
**Increased [[Hyperbilirubinemia|bilirubin]], alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
**[[Special:MyLanguage/LFTs|LFTs]]: Increased [[Special:MyLanguage/Hyperbilirubinemia|bilirubin]], alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
**Pancreatic function tests: Secretin stimulation
**Pancreatic function tests: Secretin stimulation
**Gamma-globulin IgG elevation (IgG4) in autoimmune
**Gamma-globulin IgG elevation (IgG4) in autoimmune
*Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref><ref>Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.</ref>
*Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref><ref>Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.</ref>
**[[Abd xray|Plain film]]: pancreatic calcifications (30%)
**[[Special:MyLanguage/Abd xray|Plain film]]: pancreatic calcifications (30%)
**CT: intraductal calcifications (insensitive for early disease)
**CT: intraductal calcifications (insensitive for early disease)
**ERCP: gold standard  
**ERCP: gold standard  


==Management==
 
==Management== <!--T:8-->
 
<!--T:9-->
*Lifestyle modifications (alcohol and tobacco cessation), dietary changes
*Lifestyle modifications (alcohol and tobacco cessation), dietary changes
*Pancreatic enzyme supplements
*Pancreatic enzyme supplements
*Acid suppression (H2-antagonist, [[PPI]])
*Acid suppression ([[Special:MyLanguage/H2 antagonist|H2 antagonist]], [[Special:MyLanguage/PPI|PPI]])
*Analgesics ([[NSAIDs]], [[opioids]], [[pregabalin]])
*[[Special:MyLanguage/analgesia|Analgesics]] ([[Special:MyLanguage/NSAIDs|NSAIDs]], [[Special:MyLanguage/opioids|opioids]], [[Special:MyLanguage/pregabalin|pregabalin]])
*Specialist referral for refractory pain
*Specialist referral for refractory pain


==See Also==
*[[Pancreatitis]]
*[[Pancreatitis Guidelines]]


==References==
==Disposition== <!--T:10-->
 
 
==See Also== <!--T:11-->
 
<!--T:12-->
*[[Special:MyLanguage/Pancreatitis|Pancreatitis]]
*[[Special:MyLanguage/Pancreatitis Guidelines|Pancreatitis Guidelines]]
 
 
==External Links== <!--T:13-->
 
 
==References== <!--T:14-->
 
<!--T:15-->
<references/>
<references/>


<!--T:16-->
[[Category:GI]]
[[Category:GI]]
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Latest revision as of 12:31, 7 January 2026

Other languages:

Background

Pancreatic anatomy
  • Chronic imflammatory changes of the pancreas causing permanent structural damage
  • Can be minimally symptomatic and presents with acute exacerbations.
  • Can lead to both long term endocrine and exocrine dysfunction


Clinical Features[1][2]

  • Pain
    • Episodic (1wk) or constant
    • Epigastric, radiating to back and left infrascapular region
    • Associated with nausea/vomiting
    • Improved with sitting up or leaning forward
  • Steatorrhea/DM
    • Late finding
    • Requires >80-90% loss of exocrine and endocrine function
  • Erythema ab igne
    • Hyperpigmentation of upper abdomen


Differential Diagnosis

Epigastric Pain


Evaluation

  • Labs
    • Lipase: Normal or slightly elevated
    • LFTs: Increased bilirubin, alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
    • Pancreatic function tests: Secretin stimulation
    • Gamma-globulin IgG elevation (IgG4) in autoimmune
  • Imaging[3][4]
    • Plain film: pancreatic calcifications (30%)
    • CT: intraductal calcifications (insensitive for early disease)
    • ERCP: gold standard


Management


Disposition

See Also


External Links

References

  1. ↑ Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1
  2. ↑ Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206
  3. ↑ Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4
  4. ↑ Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.
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