The Digestive System|
Chronic pancreatitis is defined as a continuing
inflammatory disease of the pancreas, characterised by irreversible
morphological/histological change and typically causing pain and/or permanent
impairment of function. The majority of cases of chronic pancreatitis in the
Western world occur as a result of persistent high alcohol consumption (70-80%). On the other hand only 5-10% of
alcoholics develop chronic pancreatitis suggesting that other factors may be
important in the pathogenesis of the disease. Biliary tract disease plays a
less important role in chronic pancreatitis than in the acute form of the
disease, but hypercalcaemia and hyperlipoproteinaemia (increased VLDL ?
triglycerides) predispose to chronic pancreatitis. However 20% of patients
have no apparent predisposing influences (idiopathic). The disease is most
common in males between the ages of 35 and 45 years. Most experts believe that
acute pancreatitis does not lead to chronic pancreatitis unless complications,
such as persistent pseudocysts or ductal strictures are present.
is obscure but chronic pancreatitis may result from hypersecretion of protein
which is not compensated for by an increase in ductal bicarbonate secretions.
As a result of this protein plugs form within pancreatic ducts. Such plugs are
observed in all forms of chronic pancreatitis, but in alcoholics these plugs
may enlarge to form stones containing calcium carbonate precipitates. These stones then
cause small duct obstruction and atrophy of the draining pancreatic lobules.
Pancreas shows fibrosis and atrophy of glandular tissue, dilated duct system
and calcification, but usually with preservation of the islets of Langerhans
(insulin producing cells).
of pain in chronic pancreatitis are unknown but may relate to pancreatic
secretion rather than to intraductal obstructions because not all patients
have ductal lesions. It has been suggested that alcohol can increase
pancreatic secretion and consequently cause pain in this condition; total
abstinence often provides pain relief.
Clinical features: < BACK TO TOP >
presentation is very variable; the condition may present as repeated attacks
of mild or moderately severe abdominal pain, or as persistent abdominal and
back pain (many patients with unexplained abdominal pain may have undiagnosed
other hand, the patient may be asymptomatic until pancreatic insufficiency and
impaired digestion develop.
most patients present with abdominal pain that occurs often within a few hours
of an alcoholic bout/large fatty meal.
pain is usually steady, lasting more than 24 hours, sometimes few days or even
located in the epigastrium or around the umbilicus, radiating to the back,
usually accompanied by nausea and sometimes vomiting.
may be obtained by crouching forward or leaning forward over a chair.
loss is common due to malnutrition and malabsorption.
and steatorrhoea are frequent due to impaired digestion of lipids, deficiency
of lipid soluble vitamins is often found.
Diabetes mellitus eventually develops in about one fifth of patients due to destruction of insulin secreting cells.
Diagnosis: < BACK TO TOP >
tenderness in the upper abdomen may be noted, with or without rigidity
X-ray of the abdomen may show characteristic calcifications in the pancreas
(sometimes no calcifications are found).
and CT scan can also be used to detect structural changes in the pancreas
(calcifications, duct dilation, pancreatic atrophy and fibrosis).
retrograde pancreatography can visualise the pancreatic duct system and
reveal sites of obstruction.
of pancreatic function is done to assess pancreatic insufficiency. In the
secretin-cholecystokinin test these two hormones are given intravenously
after naso-duodenal intubation has been done, pancreatic secretions are
collected and tested for the amount of bicarbonates, amylase and lipase.
tests are non-invasive and they are based on the cleavage of an orally given
marker (e.g., N-benzoyl-tyrosil-p-aminobenzoic acid) by pancreatic enzymes,
after what split segments (in the abovementioned example p-aminobenzoic acid)
are absorbed and excreted in the urine where they can be measured.
Stool collection for 5 days for measurement of fat can demonstrate the extent of steatorrhoea; trypsin level in faeces is also low.
Management < BACK TO TOP >
is no specific treatment; abstinence from alcohol is absolutely essential.
diet should be normal and nutritious but low in fat, supplements of
fat-soluble vitamins are often required.
of pancreatic enzymes as capsules [Cotazym-S Forte, Viokase, Pancrease,
Panazyme, Creon] are given during meals to help digestion; various natural
alternatives such as papaya extract can be also tried. Such treatment is
claimed to be able to reduce pain as well.
of pain (analgesics) especially before meals to counteract the postprandial
increase in pain may be tried.
case of diabetes, the patient is managed with diet and insulin.
is attempted only in selected cases where there is confirmed pancreatic
pseudocyst or dilation of the main pancreatic duct; the procedures are stones
removal during ERP (“basketing?, drainage and partial resection (major
Patients with chronic pancreatitis are at increased risk for pancreatic cancer; cancer occurs is approximately 4% of patients within 20 years after diagnosis of chronic pancreatitis.
Prognosis < BACK TO TOP >
Nutrition < BACK TO TOP >
Nutrition that alleviate or prevent Chronic pancreatitis :-
Herbs < BACK TO TOP >
Herbs that alleviate or prevent Chronic pancreatitis :-
(source : -)
3 5 June 20096December 2005
10 December 2004 Human Rights DayInternational Day of Disabled Persons
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speaker Mr NgThian Watt the Principal Trainer from
Napoleon Hill Associates MalaysiaDetails
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