This refers to a continuous ongoing low-grade inflammation of the pancreas. Because of the continuous inflammation, scar tissue develops within the pancreas. At first this may result in loss of part of the enzyme producing part of the pancreas. After a variable period of time (which could be after some weeks or months but is usually after many years), the insulin-making part of the pancreas may become destroyed.
For reasons that are not understood, many patients with chronic pancreatitis develop calcium deposits in the pancreas tissue and may form calcium stones in the pancreatic tissue & main pancreatic duct or its side branches. Blockage of the ducts by scar tissue (stricture) or stones will stop enzymes being delivered to the gut and impair digestion. The pancreatic duct may enlarge if it is blocked. Learn more.
What Causes Chronic Pancreatitis?
The cause of chronic pancreatitis is usually due to alcohol drinking in seven out of ten individuals. In three out of ten people there are other causes such as narrowing of the pancreatic duct and hereditary causes. In many cases, the cause remains unknown. If alcohol is thought to be the cause, it is essential that all alcohol drinking be stopped.
Other conditions that have been linked to pancreatitis are:
- Autoimmune problems (when the immune system attacks the body)
- Blockage of the pancreatic duct due to various reasons like trauma, Pancreas divisum (congenital anatomical problem) or Annular pancreas (congenital anatomical problem) or Abnormal joining of pancreatic & bile duct (congenital anatomical problem)
- Heredity or genetic problems
- High blood calcium levels (hypercalcemia)
- High parathyroid hormone levels due to any cause (hyperparathyroidism)
- Tropical pancreatitis
What Is The Treatment For Chronic Pancreatitis?
Many patients can be treated by medical treatment only, but a few will require surgery.
- Stop all alcohol drinking if this is the cause. If a patient works in an alcohol related industry such as a brewery or bar or pub, a change of employment is recommended. A change of lifestyle is often very helpful. Attendance at a drug addiction unit also can be very helpful.
- Ideally smokers need to stop smoking altogether. Smoking can lead to pancreatic cancer especially in-patient with chronic pancreatitis.
- Pancreatic enzyme supplements prescribed by specialist help digestion and may reduce the pain. 4. If sugar diabetes is present, then insulin treatment will be required.
- If sugar diabetes is present, then insulin treatment will be required.
- Mild pain-relieving tablets are acceptable. However they are not without side effects like hyperacidity and constipation, but worst is dependence or addiction. It is sometimes suggested that the nerves of the pancreas responsible for taking the sensation of pain to the brain should be destroyed. This may involve an injection into the back to destroy the nerves around the pancreas. Most pancreatic surgeons do not recommend this, as any effect is short-lived and can make any further surgery very difficult.
- There may be severe weight loss and even malnutrition despite attempts to take adequate amounts of pancreas enzyme supplements at home. To correct this it may be necessary to have a prolonged period of in-hospital treatment. In this case both the nutrition and pain teams will become involved. If you have sugar diabetes the diabetic team will also become involved.
- Keeping your weight up during the illness can be very difficult. At all times you will be encouraged to eat by mouth and drink what fluids you can. The nutritionist who will advise on specific diet & other ways to improve your calorie intake will see you. This includes the insertion of an NG tube into the stomach (naso-gastric tube) and giving you a continuous liquid diet down this tube. If you are unable to tolerate the NG tube a narrow tube will be inserted into the small bowel (jejunum) using a flexible endoscope. This is like regular endoscopy and is done with local anesthetic spray to the back of the throat and intravenous sedation. The tube is called an NJ tube or naso-jejunal tube and the feeding with a liquid diet slowly dripped in using this tube is called nasojejunal feeding. Alternatively you may be fed with a PEG tube (percutaneous endoscopic gastrostomy). A PEG tube is inserted using a flexible endoscope, inflating the stomach with air and pushing a guide wire through the skin into the stomach. A permanent feeding tube is then passed over the guide wire into the stomach. With a PEG tube you can eat and drink as much as you feel like. Any extra calories can then be given using a liquid diet dripped into the PEG tube. You may well be sent home with the PEG tube still present.
- Sometimes extra feeding has to be given straight into a vein and is called parenteral feeding. This can be done by inserting a long catheter (tube) into a vein in one of the arms and then the tip is pushed into one of the large veins close to the heart (this is called a PIC line). If the arm veins are collapsed then a catheter will need to be pushed into one of the neck veins and then the tip is pushed towards the large veins near the heart. This is sometime called TPN or total parenteral nutrition.
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