Chronic fibro-inflammatory disease of the pancreas, resulting in progressive and irreversible damage to the pancreatic parenchyma; damage results in loss of exocrine +/- endocrine function
Aetiology
Chronic alcohol abuse - 60-80%
Idiopathic
Pancreatic duct obstruction (congenital or acquired)
Autoimmune
Tropical countries - areas deficient in methionine, zinc and selenium
Hereditary - cystic fibrosis, ⍺1-antitrypsin
Clinical presentation
Chronic epigastric/back pain
Pain often associated with nausea and vomiting
Endocrine insufficiency - impaired glucose regulation or eventual diabetes mellitus
Often concurrent psudocysts are present due to previous recurrent attacks of acute pancreatitis - patients may present with symptoms of mass effect e.g. biliary obstruction or gastric outlet obstruction
Investigations
Imaging
CT pancreas - pancreatic calcification or atrophy, pseudocysts
MRCP - if CT findings inconclusive
AXR - pancreatic calcifications (highly specific but only seen in ~30% of cases)
USS
ECRP - distorted pancreatic ducts
Management
Manage acute episodes appropriately
CREON in exocrine pancreas insufficiency
Surgery - anastomoses of pancreatic duct and jejunum (Puestow), removal of the diseased portions in head of pancreas (Frey)
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