Definition and Etiology
• It is a picture characterized by irreversible fibrosis of the pancreas, loss of exocrine and endocrine function, irregular dilatation of the pancreatic ducts and abdominal pain.
• The most common cause is alcohol.
TIGAR-O calcification in chronic pancreatitis and pancreatic exocrine insufficiency
Toxic-metabolic
Alcohol
Cigarette
hypercalcemia
hyperlipidemia
chronic kidney disease
Medicines
Autoimmune
Type 1 autoimmune pancreatitis (lgG4 +)
Type 2 autoimmune pancreatitis (lgG4 -)
Idiopathic
early start
late start
Tropical
Recurrent and severe acute pancreatic
Postnecrotic (severe pancreatitis)
Recurrent acute pancreatitis
Vascular diseases/ischemia
Radiation
Genetic
Cationic trypsinogen (PRSS1)
Cystic fibrosis transmembrane regulation (CFTR)
Calcium-sensitive receptor (CASR)
Chymotrypsin C gene (CTRC)
Pancreatic secretory trypsin inhibitor gene (SPINK1)
Obstructive
pancreas divisum
Duct blockage (such as a tumor)
Periampullary duodenal wall cyst
Posttraumatic pancreatic duct scar
Clinic
• The most common symptom is pain. It is mostly blunt, spreading to the subcostal region and back.
• Over the years; pancreatic calcification, steatorrhea, malabsorption and diabetes develop.
• Weight loss is common.
• Patients are prone to hypoglycemia (glucagon deficiency).
Diagnosis
• Low fecal elastase level is helpful in the diagnosis of severe pancreatic insufficiency.
Its sensitivity is low in mild to moderate insufficiency.
• Since pancreatic enzymes are required for fat absorption, a deficiency of fat-soluble ADEK vitamins can be observed in the deficiency of these enzymes. In addition, the level of vitB12 decreased.
• The most sensitive test in diagnosis is the analysis of secretin-stimulated pancreatic exogenous secretion.
• High resolution CT is primarily recommended in the approach to a patient with suspected chronic pancreatitis. The alternative is MR/MRCP. In the later approach, endoscopic ultrasonography is recommended, and in undiagnosed cases, secretin stimulation test is recommended.
• Although it is not recommended to use ERCP for diagnostic purposes only, ERCP is the last step in cases where the diagnosis cannot be made despite secretin stimulation test.
• In imaging methods; Pancreatic calcification, irregular contours, parenchymal heterogeneity and atrophy, irregularity or dilatation in the pancreatic duct are important findings for diagnosis.
Complications of chronic pancreatitis
• Chronic abdominal pain
• Wrapped
• Narcotic addiction
• Biliary stricture, biliary cirrhosis
• Diabetes or glucose intolerance
• pseudocyst
• Gastroparesis
• Metabolic bone disease
• Malabsorption/digestive disorder
• Pancreatic cancer
Treatment
• Oral pancreatic enzyme extracts, PPI or H2RA (to prevent degradation of enzymes with low gastric pH), pain relievers, octreotide can be used.
• A diet containing medium chain fatty acids is recommended.
• Endoscopic (stent) or surgical decompression can be performed in refractory cases.
• It is a picture characterized by irreversible fibrosis of the pancreas, loss of exocrine and endocrine function, irregular dilatation of the pancreatic ducts and abdominal pain.
• The most common cause is alcohol.
TIGAR-O calcification in chronic pancreatitis and pancreatic exocrine insufficiency
Toxic-metabolic
Alcohol
Cigarette
hypercalcemia
hyperlipidemia
chronic kidney disease
Medicines
Autoimmune
Type 1 autoimmune pancreatitis (lgG4 +)
Type 2 autoimmune pancreatitis (lgG4 -)
Idiopathic
early start
late start
Tropical
Recurrent and severe acute pancreatic
Postnecrotic (severe pancreatitis)
Recurrent acute pancreatitis
Vascular diseases/ischemia
Radiation
Genetic
Cationic trypsinogen (PRSS1)
Cystic fibrosis transmembrane regulation (CFTR)
Calcium-sensitive receptor (CASR)
Chymotrypsin C gene (CTRC)
Pancreatic secretory trypsin inhibitor gene (SPINK1)
Obstructive
pancreas divisum
Duct blockage (such as a tumor)
Periampullary duodenal wall cyst
Posttraumatic pancreatic duct scar
Clinic
• The most common symptom is pain. It is mostly blunt, spreading to the subcostal region and back.
• Over the years; pancreatic calcification, steatorrhea, malabsorption and diabetes develop.
• Weight loss is common.
• Patients are prone to hypoglycemia (glucagon deficiency).
Diagnosis
• Low fecal elastase level is helpful in the diagnosis of severe pancreatic insufficiency.
Its sensitivity is low in mild to moderate insufficiency.
• Since pancreatic enzymes are required for fat absorption, a deficiency of fat-soluble ADEK vitamins can be observed in the deficiency of these enzymes. In addition, the level of vitB12 decreased.
• The most sensitive test in diagnosis is the analysis of secretin-stimulated pancreatic exogenous secretion.
• High resolution CT is primarily recommended in the approach to a patient with suspected chronic pancreatitis. The alternative is MR/MRCP. In the later approach, endoscopic ultrasonography is recommended, and in undiagnosed cases, secretin stimulation test is recommended.
• Although it is not recommended to use ERCP for diagnostic purposes only, ERCP is the last step in cases where the diagnosis cannot be made despite secretin stimulation test.
• In imaging methods; Pancreatic calcification, irregular contours, parenchymal heterogeneity and atrophy, irregularity or dilatation in the pancreatic duct are important findings for diagnosis.
Complications of chronic pancreatitis
• Chronic abdominal pain
• Wrapped
• Narcotic addiction
• Biliary stricture, biliary cirrhosis
• Diabetes or glucose intolerance
• pseudocyst
• Gastroparesis
• Metabolic bone disease
• Malabsorption/digestive disorder
• Pancreatic cancer
Treatment
• Oral pancreatic enzyme extracts, PPI or H2RA (to prevent degradation of enzymes with low gastric pH), pain relievers, octreotide can be used.
• A diet containing medium chain fatty acids is recommended.
• Endoscopic (stent) or surgical decompression can be performed in refractory cases.