Chronic pancreatitis

• Clinical presentation


  • Pain
  • Exocrine insufficiency
  • Diarrhoea / steatorrhoea/ fat soluble vitamin deficiency
  • Endocrine insufficiency
  • Diabetes mellitus
  • Extrapancreatic complications
  • Obstructive jaundice
  • Haemosuccus pancreaticus
  • Gastric outlet obstruction/ bowel obstruction
  • Pancreas cancer
• Abdominal pain


  • Increased intraductal pressure
  • Increased intracompartmental pressure
  • Altered peripheral and central nociceptors
• Exocrine insufficiency


  • Occurs when there is less than 10% of maximum enzyme output
  • Steatorrhoea first then azotorrhoea
  • Advanced CP characterised by carbohydrate, protein and fat maldigestion
  • Fat soluble vitamin deficiencies especially D and K
  • Median time to development 13yrs in alcoholic CP
• Endocrine insufficiency


  • Islets cells are resistant to fibrosis, so endocrine insufficiency develops late
  • Patients develop type 3 diabetes, a combination of insulin deficiency and insulin resistance
• Extra-pancreatic complications


  • Obstructive jaundice from CBD stricture
  • Haemosuccus pancreaticus from pseudo-aneurysm-can also get usual GIT bleeds or left sided portal hypertension
  • GOO or bowel obstruction from duodenal or colonic fibrosis
• Diagnosis


  • Radiological imaging
  • AXR
  • CTAP/MRCP-MRI
  • EUS
  • Functional tests
• Radiological imaging


  • AXR
  • Abdominal CT
  • MRCP
• Endoscopic ultrasound


  Rosemont criteria: duct and parenchymal changes
• Functional tests


  • Serum amylase and lipase are of no value
  • Non-invasive: Fecal elastase 1: >200ug/g feces is normal, Total fecal fat-24hour test
  • Invasive: Lundh test, Secretin stimulation test
• How to diagnose CP

  • Calcifications in the pancreas
  • Exocrine dysfunction with fecal elastase <200
• CP etiology is varied, but the most common causes are chronic alcohol consumption and smoking
• CP patients have typical presentations, pain is the most common symptom and results in opioid dependence
• There are pancreatic and extra-pancreatic complications
• Treatment requires a multi-disciplinary team approach