Pancreatitis is the chronic inflammation of the pancreas. There are acute and chronic forms. This section discusses chronic pancreatitis. This is defined as a chronic disease of the pancreas, which continues to progress until it comes to the loss of exocrine and later endocrine glands. Above all, men between the ages of 30 and 40 are affected.
Cause (s) of chronic pancreatitis
In Western countries, the most common cause of chronic pancreatitis is alcohol abuse. It is believed that consuming more than 80 grams of alcohol per day in men, more than 40 grams in women, leads to irreparable damage after four to eight years.
The exact relationships are not yet known in detail. It is known that alcohol interferes with numerous mechanisms in the body and thus also leads to damage to the pancreas. According to the underlying disease, the inflammation is often chronic in character, although even a single alcohol excess sufficient to trigger an (acute) pancreatitis.
Rare causes include: arteriosclerosis, malformations, biliary tract disorders, disorders in hormone and fat metabolism, injuries, obstruction of the pancreatic duct. Often, however, the cause of chronic pancreatitis remains unknown.
Chronic pancreatitis: typical symptoms
The chronic pancreatitis manifests itself in dull, but sometimes also cutting pain in the upper abdomen, which initially occur occasionally and can be triggered by eating or drinking alcohol. The pain can radiate up to the back. Later, the pain persists for days or even weeks. The patients huddle together because the pain is so much better. There are also painless forms (5 percent of cases). Bloating, nausea, nausea and flatulence may occur.
In the course of chronic pancreatitis indigestion develops. However, these only show up when the pancreas already provides only 10 to 20 percent of its normal exocrine performance. It comes to greasy bowel movements, the chair weight increases. Weight loss and jaundice are also possible.
Diagnosis of chronic pancreatitis
Diagnosis includes the clinical examination, in which pressure pain is found in the upper and middle abdomen. The body weight in relation to the body size may be reduced. Increases in pancreatic enzymes are not evidence of chronic pancreatitis. They merely indicate inflammation (see also acute pancreatitis) or suggest that secretions are retained (for example, in cysts). In advanced disease, steatorrhea develops and stool weight increases to over 300 grams per day.
Different diagnostic procedures
The outline of the pancreas can be examined ultrasonically and calcifications can be determined. In an X-ray, any existing calcifications are also visible. Calcification can be found in 70 percent of those affected. Further details (extent of tissue destruction, bleeding) are presented by computed tomography.
In an ERCP, the ducts of the pancreas and the bile ducts can be visualized and any constrictions can be detected. Restrictions may possibly be increased endoscopically during the examination and gallstones are removed.
With a cholangiogram narrowing of the bile duct or congestion of the same can be seen. To exclude a pancreatic carcinoma, if necessary, a biopsy under ultrasound or a surgical opening of the abdominal cavity is performed. In addition to the imaging techniques, tests to measure the functionality of the pancreas play an important role: Here, the excretion of certain enzymes is measured with the stool. Excretion of chymotrypsin decreases below 5 units per gram of stool.
In the so-called Pankreolauryltest a fluorescent substance is administered. This substance is normally split by pancreatic enzymes called esterases. Since fewer enzymes are present in chronic pancreatitis, this split occurs to a lesser extent. By measuring how much fluorescein is excreted in the urine over 24 hours, the extent of functional impairment can be determined.
The most sensitive test, however, is the secretin-pancreozymin test: After the pancreas has been stimulated, secretions are removed from the duodenum using a probe. Bicarbonate and pancreatic enzymes are then measured in this secretion. With this test, a functional restriction can be detected early.
Course of a chronic inflammation of the pancreas
In the course of the disease, the exocrine function of the pancreas first fails, which leads to digestive problems. Later, a diabetes mellitus develops through the disruption of endocrine function.
Chronic pancreatitis is a progressive disease. In general, a stage of acute inflammation following a symptom-free stage (circa 5 years) follows, leading to disturbances in exocrine and endocrine function after a further 5 years. The life expectancy of the patients is diminished and the prognosis is poor if alcohol continues to be consumed.
In about 50 percent of cases, cysts form. If the cysts reach a height of more than 5 cm, they must be surgically removed. There is then the possibility that they burst, their content is released and the enzymes contained attack blood vessels. This can lead to heavy bleeding.
Another complication may be narrowing of the nearby duodenum. Stenosis of the bile duct may lead to jaundice. Also a thrombosis of the splenic vein with enlargement of the spleen is possible. Pancreatic carcinomas appear to be somewhat more common in people with chronic pancreatitis. Relapses of acute pancreatitis occur especially in the first phase of the disease.
Treatment of chronic pancreatitis
Conservative treatment consists of the following measures:
- Absolute alcohol ban!
- Nutritional change to high-calorie, but low-fat diet, ie many carbohydrates and proteins.
- In diabetes, insulin is administered.
Surgery may become necessary if complications occur or persistent pain persists. In the course of surgery, parts of the pancreas may be removed or additional pancreatic secretions may be introduced into the intestine. Cysts are removed or may be punctured under ultrasound guidance.