Chronic Pancreatitis

Chronic pancreatitis is characterized by irreversible pancreatic damage which can lead to serious health concerns, such as pancreatic insufficiency, fat malabsorption, glucose intolerance, duodenal stenosis, splenic vein thrombosis, pleural effusions, and pancreatic cancer. Patients may present with episodic epigastric abdominal pain that can radiate to the back early in the disease process, which will eventually become continuous. Serum amylase and lipase may be normal, and liver function tests (LFTs) can become elevated if there is compression of the intrapancreatic portion of the common bile duct. Diagnosis can be made by obtaining a right upper quadrant (RUQ) ultrasound, computed tomography (CT), or magnetic resonance imaging (MRI) showing pancreatic calcifications. Secretin study will also be abnormal. Magnetic resonance cholangiopancreatography (MRCP) will show beading and irregularity of the pancreatic duct with enlarged side branches. An endoscopic ultrasound (EUS) should be performed to rule out pancreatic cancer and to aid in diagnosis. Patients with chronic pancreatitis should be counseled on smoking and alcohol cessation, adequate hydration, and maintenance of low-fat diet. Treatment should include pancreatic enzyme supplementation, tricyclic antidepressants (TCAs), nonsteroidal anti-inflammatory drugs (NSAIDs), and opiates, if needed, for pain. If the symptoms persist, consider endoscopic retrograde cholangiopancreatography (ERCP) with pancreatic duct stent placement. If a benign biliary stricture is present, a common bile duct stent may be necessary. Surgical approaches may be helpful for decompression or drainage with autologous islet cell transplantation in patients with pancreatic insufficiency post-resection.