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 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.
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 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.