• QAIH, 6th floor, Near Golra Morr, Pesahawar Rd, H-13, Islamabad.
  • Mon - Sat 8.00 - 18.00. Sunday CLOSED

Chronic pancreatitis

Chronic pancreatitis

Chronic pancreatitis in adults

Patient’s information

Pancreas: The pancreas is a gland that lies across the back of your upper abdomen, behind the stomach and guts (intestines) and in front of the spine and just above the level of your belly button (umbilicus). Its shape is like a cylinder and is about 15cm long and 3cm wide. Chronic pancreatitis has two main functions

  • Exocrine function: It produces a fluid called “pancreatic juice” that flows through a small tube in the center of the pancreas called the pancreatic duct into your small intestine (duodenum). Pancreatic juice helps to digest the food so that the proteins, fats, and carbohydrates can be digested and then absorbed into the bloodstream and used for energy for other body functions.
  • Endocrine function: Groups of special cells called ‘Islets of Langerhans’ are scattered throughout the pancreas. These cells make the hormones insulin and glucagon. The hormones are passed (secreted) directly into the bloodstream to control the blood sugar level in the body.

The bile duct carries bile from the liver and gallbladder. This joins the pancreatic duct just before it opens into the duodenum. Bile passes into the duodenum and helps to digest food.

Chronic pancreatitis

Pancreatitis means inflammation of the pancreas. There are two types.

Acute pancreatitis – when the inflammation develops quickly, over a few days or so. It usually goes away completely and leaves no permanent damage to the pancreas. Sometimes it is serious.

Chronic pancreatitis – when the inflammation is persistent. The inflammation tends to be less intense than acute pancreatitis but as it is ongoing it can cause scarring and damage. About 4 in 100 people across the world at any one time have chronic pancreatitis

It is not known how many people in Pakistan have this condition but it is thought to have increased considerably over the years.  It is more common in men than in women.

Acute pancreatitis

Alcohol – is the common cause in the western world. Men aged 40-50 are the most common group of people affected. In most cases the person has been drinking heavily for 10 years or more before symptoms first begin.

Smoking – has recently been found to be linked to chronic pancreatitis.

Genetic conditions – there are some rare genetic conditions which can lead to chronic pancreatitis developing. Cystic fibrosis can be one cause.  Genetic means the you are born with it and it is passed through families though special codes inside cells called genes.

Autoimmune conditions – your own immune system attacks the pancreas. This can be associated with other autoimmune diseases – for example, Sjörgren’s syndrome and primary biliary cirrhosis.

Other causes – are uncommon. They include abnormalities of the pancreas such as narrowing of the pancreatic duct (due to various reasons) and conditions inherited from one of your parents (hereditary).

Malnutrition – and eating lots of cassava may be a cause in some countries.

Unknown – in some cases no cause can be identified. No cause is found in around 2 out of 10 cases of chronic pancreatitis.

Note: gallstones, which are a common cause of acute pancreatitis, do not cause chronic pancreatitis unless the little tube which attached the gallbladder to the liver (the bile duct) is damaged by a stone or by infection.

A persistent inflammation develops in the pancreas. The reason why alcohol or other factors trigger this inflammation is not clear, although in some people it is thought to relate to their genes. Over time the inflammation causes scarring and damage to parts of the pancreas. This can then lead to not enough chemicals (enzymes) and insulin being made. A lack of enzymes causes poor digestion of food (malabsorption). A lack of insulin causes diabetes. Over time clumps of calcium are deposited and can form stones in the pancreas. Calcium stones and/or scarring of the pancreatic ducts may block the flow of enzymes along the pancreatic ducts. Chronic pancreatitis often becomes worse with time. The time from the initial triggering of inflammation to damage, scarring, calcium stones, and then to developing digestion problems or diabetes, is often several years. However, many months or years of this process can go on before any symptoms are first noticed.

what happen in chronic pancreatitis

The symptoms can vary between cases. The most common symptoms include:

Tummy (abdominal) pain – just below the ribs is common. The pain is typically felt spreading through to the back. It tends to be persistent and may be partly eased by leaning forward. It may be mild at first but can become severe. Eating often makes the pain worse. This may lead to your eating less and then losing weight. The pain can be intermittent so not present all the time.

Note: around 1 person in 5 with chronic pancreatitis does not have any abdominal pain. Poor digestion (malabsorption) – occurs if not enough enzymes are made by the damaged pancreas. In particular, the digestion of fats and certain vitamins is affected. Undigested fat from the diet may remain in the gut and be passed with stools (faeces). This causes pale, smelly, loose stools that are difficult to flush away (steatorrhoea). Weight loss can also occur if food is not fully digested.

Diabetes – occurs in about 1 in 3 cases. This occurs when the pancreas cannot make sufficient insulin. Symptoms usually include excess thirst, passing large amounts of urine and further weight loss unless the diabetes is treated. However, chronic pancreatitis is actually an uncommon cause of diabetes.

Feeling sick (nausea) – and generally feeling unwell may also occur.

Unfortunately, there is currently no single test for chronic pancreatitis. Diagnosing chronic pancreatitis in its early stages is often difficult. Many pancreatic cells can be damaged before abnormalities show up on tests, X-rays or scans. The amount of enzymes made by the pancreas and the number of insulin-producing cells can become quite low before any symptoms of poor digestion or diabetes develop. Once the damage and scarring to the pancreas is more severe, or when calcium stones start to form, then the damaged pancreas can be detected by X-rays or scans. However, by this time the malabsorption or symptoms of diabetes may have already developed.

Tests done usually include:

  • Blood tests to check your blood count, kidney and liver function.
  • Blood tested for diabetes.
  • Your doctor may also request a sample of your faeces (poo, stools or motions) for testing.
  • An X-ray or CT scan of your tummy (abdomen) may be performed.
  • A cholangiogram is a test which produces a picture of the bile ducts. This is often done using an MRI scan.
  • Looking at the pancreas with a telescope put down into your stomach. Occasionally, dye is squirted up the tube leading to the pancreas (the pancreatic duct) to obtain a clearer picture of what is going on.

Most people with chronic pancreatitis do not have complications. However, the following may occur:

  • Pseudocyst – develops in about 1 in 4 people with chronic pancreatitis. This is when pancreatic fluid, rich in chemicals (enzymes), collects into a cyst due to a blocked tube which leads to the pancreas (the pancreatic duct). These can swell to various sizes. They may cause symptoms such as worsening pain, feeling sick and vomiting. Sometimes they go away without treatment. Sometimes they need to be drained or surgically removed.
  • Ascites – sometimes occurs. This is fluid that collects in the tummy (abdominal) cavity between the organs and guts (intestines).
  • Blockage of the bile duct – is an uncommon complication. This causes jaundice as bile cannot get into the gut and leaks into the bloodstream. This makes your skin look yellow.
  • Cancer of the pancreas – is more common than average in people with chronic pancreatitis. The risk increases in smokers and with increasing age
  • Rare complications – include blockage of the gut, bleeding or blood clot (thrombosis) in blood vessels near to the pancreas.

It is fairly common to feel low when you have chronic pancreatitis, especially if you are in pain. Some people even become depressed, which can respond well to treatment. It is important to talk to your doctor about any symptoms of depression you may have.

  • Stop drinking alcohol for good – this is the most essential part of treatment. You should not drink alcohol even if it is not the cause of your chronic pancreatitis.
  • Painkillers – are usually needed to ease the pain. Controlling the pain sometimes becomes quite difficult and referral to a pain clinic may be needed. Apart from painkillers, other techniques to block the pain may be considered, such as nerve blocks to the pancreas.
  • Enzyme replacement medication – may be needed if the low level of chemicals (enzymes) causes poor digestion of food and steatorrhoea. Capsules containing artificial enzymes are taken with meals.
  • Restricting fat in the diet – may be advised if steatorrhoea is bad.
  • Insulin – if diabetes develops then insulin injections will be needed to control the blood sugar level.
  • Vitamins – may need to be taken.
  • Do not smoke – to minimize the risk of pancreatic cancer developing.

If you have autoimmune pancreatitis then you may be given a course of steroid tablets.

Surgery -Most people with chronic pancreatitis do not need surgery but an operation is sometimes needed. The common reason for surgery is for persistent bad pain that is not helped by painkillers or other methods. Improvement in pain occurs in about 7 in 10 patients who have surgery. The operation usually involves removing part of the pancreas. There are different techniques that remove different amounts of pancreas. The one chosen depends on the severity of your condition, whether the pancreatic duct is blocked, and also on various other factors. Other operations may be advised in some cases – for example, removal of a large calcium stone that is blocking the main pancreatic duct. Another procedure that may help in some people is to ‘stretch’ wide a narrowed pancreatic duct to allow better drainage of pancreatic enzymes. Surgery may also be needed if a complication develops. For example, if a blocked bile duct or pseudocyst develops. If the pain is persistent you may be offered a procedure to block the nerve supply to the area. Examples of treatments that involve this approach are coeliac plexus block and spinal cord stimulation. If you need surgery, then your surgeon will be able to discuss with you in detail the type of operation you need.

treatment of chronic pancreatic

If alcohol is the cause of chronic pancreatitis then other alcohol-related illnesses also commonly develop.  If you continue to drink alcohol and pancreatitis becomes severe than life expectancy is typically reduced by 10-20 years. This is due to complications of pancreatitis or to other alcohol related illnesses. If you stop drinking alcohol completely in the early stages of the condition, the outlook is better. The outlook for other less common causes of chronic pancreatitis depends on the cause and severity of the condition.

If you have any further questions or worries please feel free to ask the staff on your ward, your surgical team or your clinical nurse specialist.

 

Patient Help Line (PHL) is a service that offers support, information and assistance to patients, relatives and visitors. They can also provide help and advice if you have a concerns.

The PHL office is located on the ground 6th floor of the “Quaid e Azam International Hospital”, Islamabad our staff will be happy to help and assist you.

Transplant coordinator:

Mr. Touseef Ahmed 0333-1027353

Transplant Coordinator: (for post-transplant follow up patients):

M. Zaheen Hashmi 0333-1027354

Hepatobiliary & Pancreatic Surgery Services:

Muhammad Asif 0341-0543883

24 Hours Patients emergency Helpline: 0333-1027356

Email: info@faisaldar.com

Counselling service: The counselling service offers free and confidential sessions to our inpatients, outpatients, their relatives and friends. If you would like to meet with one our counsellors you can contact us on 0333-1027356

New Life Health Services at Quaid e Azam International Hospital”, Islamabad, Pakistan

Transplant coordinator:

Mr. Touseef Ahmed 0333-1027353

Transplant Coordinator: (for post-transplant follow up patients):

M. Zaheen Hashmi 0333-1027354

Hepatobiliary & Pancreatic Surgery Services:

Muhammad Asif 0341-0543883

24 Hours Patients emergency Helpline: 0333-1027356

Email: info@faisaldar.com

Website: www.faisaldar.com

Hi, How Can We Help You?