In association with:
Primary Care Society
for Gastroenterology
INFORMATION ABOUT
Chronic Pancreatitis
www.corecharity.org.uk
What is the Pancreas?
What does it do?
What is chronic pancreatitis?
What causes chronic pancreatitis?
What symptoms do you get?
How is it diagnosed?
How can chronic pancreatitis be treated?
What is the pancreas?
The pancreas is part of the digestive system. It
lies high up in the upper half of the abdomen
behind the stomach and in front of the spine.
It is a solid flat gland about nine inches long,
salmon pink in colour and shaped like a comma.
2
The larger end is the head and the
smaller end is the tail; in between is
the body of the pancreas. The head
is attached to the first part
of the
small intestine (duodenum), where
all the food enters from the stomach.
The tube (bile duct), which carries
bile from the liver to the intestines,
passes through the head of the
pancreas where it is joined by the
tube carrying the pancreatic digestive
juices. The main blood vessels of the
intestines go under the pancreas.
The pancreas has two main functions.
It produces digestive juice (enzymes
which help to digest food) and insulin
(a hormone which balances the sugar
in your blood). The digestive juice
flows into the duodenum and mixes
with the food and bile to digest food.
It also produces other hormones,
which help with digestion and
bicarbonate to balance the acid from
the stomach.
What causes chronic
pancreatitis?
What is chronic pancreatitis?
Chronic pancreatitis is the result of
damage to the pancreas. Damage to
the pancreas can result from a number
of different causes – see below. These
can each result in inflammation
of the pancreas, which results in
scarring, fibrosis, and sometimes the
development of calcium deposits in the
gland. The scarring can result both in
reducing insulin production from the
pancreas and a reduction in enzyme
production. This can result in failure to
absorb fats or proteins.
The scarring can result in different
problems in different people. In some
people, nerves can get irritated, causing
pain. In others, the scarring can result
in acute attacks of inflammation. In
other people, the scarring can produce
a lump in the pancreas, which can
cause narrowing of the end of the pipe
between the liver and the bowel (the
bile duct). This can result in jaundice.
In other patients, the inflammation
can produce cysts on the pancreas
(pseudocysts). Sometimes, scarring can
cause a narrowing in the drainage tube
from the pancreas (the pancreatic duct
– stricture). Insulin production can drop
causing diabetes.
There are many causes of chronic
pancreatitis but in the UK, most
are associated with alcohol intake.
Alcohol is toxic to the pancreas and
some people are more susceptible to
damage from alcohol than others.
Other causes include a follow-on
of damage from acute pancreatitis,
some patients develop chronic
pancreatitis because of an inherited
tendency related to trypsinogen
and inhibitory protein defects.
Other causes include cystic fibrosis,
following trauma and auto-immune
problems; in some people who
develop chronic pancreatitis, the
cause is not understood.
What symptoms do you get?
There are a number of
other problems.
• Reduction in insulin production,
which can lead to diabetes.
•
Reduction in enzyme secretion –
fat malabsorption. This causes
motions to become pale and
bulky and frequently difficult
to flush away. The result is
weight loss.
•
Chronic pain. This is usually felt in
the upper abdomen and back
and can vary from mild to very
severe and unremitting.
•
Recurrent flare-ups of acute
inflammation. This can result
in sudden onset of upper
abdominal pain, vomiting and
inflammation.
•
Cyst formation. Sometimes,
damage to the pancreas
can produce cysts on the
pancreas (pseudocysts).
Chronic pancreatitis causes two main
problems. These are chronic pain and
pancreatic insufficiency, which means
a reduced ability of the pancreas to
produce insulin and enzymes that
help to digest fats.
• Blockage of the bile duct
causing jaundice.
• Blockage of the duodenum
causing vomiting.
3
How is it diagnosed?
4
The diagnosis of chronic pancreatitis is
based on typical clinical features such as the presence of fat malabsorption
causing weight loss and characteristic
upper abdominal and back pain.
Sometimes, these are not present and
people can present with recurrent
attacks of acute inflammation.
The diagnosis is usually confirmed
with tests. These can include imaging
such as ultrasound and CT scans. CT
scans can reveal various features such
as calcification within the pancreas,
a lump in the pancreas, dilatation of
the pancreatic duct or cyst formation. Other tests can be helpful to
confirm the diagnosis and look more
closely into the effects of chronic
pancreatitis. These tests include
endoscopic ultrasound scanning
or magnetic resonance scanning
of the pancreas, which can look for
narrowing in the pancreatic duct.
There are also tests, which measure
the amount of fat that is not being
absorbed in the gut.
How can chronic pancreatitis
be treated?
Surgery
Surgery is available in specialised
centres for some suitable patients.
Two types of operation are commonly
employed. These sometimes involve
removing the most affected part of
the pancreas or other operations
which involve draining the affected
pancreas straight into another part
of the bowel. These operations will
not help everybody but typically, good
results are obtained in six or seven
out of ten patients.
Other operations are sometimes
required to correct the complications
of chronic pancreatitis such as
cyst formation. Cysts sometimes
need draining which can be done
both surgically and endoscopically
depending on the suitability of the cyst.
The treatment for chronic
pancreatitis depends on which
problems the chronic pancreatitis
is causing, and this can be very
different in different patients.
Treatment is directed whenever
possible to correction of the
underlying cause, to relieve pain
and correct fat malabsorption and
reverse weight loss. Diabetes may
occur and will need treatment with
drugs or insulin.
The abdominal pain can be quite
severe and require treatment
with either simple pain killers or
sometimes opiates.
To reverse the fat malabsorption,
replacement pancreatic enzyme
capsules are available.
What research is needed
Further research is needed on
effective pain control in chronic
pancreatitis and in better controlling
the fat malabsorption that occurs.
Research into the cyclical process of
inflammation and fibrosis is needed
- if this could be controlled it might
be possible to prevent the progressive
destruction of the pancreas. It is
also important to find out why some
people who drink alcohol are affected
but others who seemingly drink
similar amounts have no problems.
Endoscopic Procedures
Sometimes, an endoscope can be
used to widen areas of narrowing
in the pancreas or to remove stones
which can, in a few patients, result in
symptom improvement.
5
Anatomy of the Pancreas
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Updated December 2011
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