What is chronic pancreatitis
In chronic pancreatitis widespread injury to the pancreas over many years
cause extensive scaring and destruction of the pancreas. This condition
is mostly frequently associated with alcohol abuse and excessive smoking.
In many patients this condition may develop without any apparent cause.
Chronic pancreatitis is a slowly progressive disease that takes many
years to develop and leads to destruction of pancreatic tissue. In many
patients chronic pancreatitis is often silent and may not cause any symptoms.
Patients with chronic pancreatitis are at risk for developing
the following problems:
Severe
chronic or long term pain: Severe pain is the most important
and most difficult to treat complication of chronic pancreatitis. Many patients
will come to some form of operative or non-operative management for their
pain. Non-operative options include
placement of stents in the pancreatic duct or endoscopic removal of pancreatic
duct stones. These treatments provide temporary pain relief at best
and are not useful for long-term pain relief.
For long-term pain
relief surgical treatment is often the only option.
A number of different types of surgical
procedures are available for treatment of patients with chronic pancreatitis
and the procedure should be tailored to an individual patient to provide
the best chance for relief of the pain.
Diabetes
mellitus: Diabetes is a frequent complication in chronic
pancreatitis. Diabetes develops from destruction of insulin producing
cells in the pancreas caused by the inflammation found in chronic pancreatitis.
The diabetes that develops in chronic pancreatitis is very difficult to
treat and usually requires insulin injections.
Poor
absorption of nutrients from the digestive tract: Pancreas
produces the enzymes that digest the food that we eat. In chronic pancreatitis
less of these enzymes are produced as the pancreas is progressively destroyed
by the inflammation. This causes poor absorption of nutrients, especially
fats from the digestive tract.
Pancreas
Cancer: A higher incidence of pancreatic
cancer has been reported in chronic pancreatitis.
Bile
duct blockage: Bile duct obstruction is common and
occurs in up to 50% of patients with chronic pancreatitis.The bile duct
becomes blocked as it passages through the inflamed pancreas.
Pseudocyst:
pseudocyst is a swelling that develops on the pancreas and is often
due to leakage of pancreatic secretion outside of the pancreas. Formation
of scar tissue around the leakage cause a swelling called a pseudocyst.
Patients with pseudocyst often present with abdominal pain that is aggravated
by meals. In some patients a pseudocyst develops without any symptoms.
Surgery is usually needed when the pseudocyst is causing symptoms. At
USC we offer laparoscopic surgery for
the treatment of pancreatic pseudocyst. With this unique approach
the length of hospital stay is reduced just to one to three days and the
post operative recovery is rapid with most patients going back to work
within a within two weeks.
Vascular (blood
vessel) abnormalities: occasionally the inflammation from
chronic pancreatitis can injure the surrounding blood vessels. Vascular
complications of chronic pancreatitis are extremely uncommon.
Splenic vein thrombosis develop when the splenic vein
which is behind the pancreas is occluded due to the inflammation. Patients
with this abnormality often develop abnormal communicating veins between
the stomach and spleen can lead to massive hemorrhage from the stomach.
Removal of
the spleen is the treatment of choice for this complication. This procedure
is performed laparoscopically at USC.
In some patients the splenic artery is injured by the inflammation that
can lead to an aneurysm (abnormal enlargement) of the splenic
artery. This aneurysm can rupture leading to massive internal
hemorrhage.
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