The pancreas is a spongy, leaf-shaped gland in the abdomen that is part of the endocrine system. It is about 6 inches long and 2 inches wide. It lies in the back of the abdomen, behind your stomach and small intestine. The pancreas has two very important functions. First, it makes enzymes (digestive juices) that are released into your intestines to allow you to break down and absorb nutrients from your food. Secondly, it produces enzymes (insulin and glucagon), which control the level of sugar in the blood. Chronic pancreatitis is a condition involving progressive inflammatory damage to the pancreas that can eventually lead to permanent structural and functional damage.
Acute pancreatitis is an inflammatory response to pancreatic injury that is usually not progressive or permanent. Recurrent episodes of acute pancreatitis can eventually lead to permanent damage, but this is not the norm.
The 2 primary clinical manifestations of chronic pancreatitis are abdominal pain and symptoms related to pancreatic dysfunction. Abdominal pain is the most common symptom related to chronic pancreatitis and typically is located in the upper abdomen. The pain can radiate to the back and can be associated with nausea or vomiting. The pain can last several days at a time or can even be fairly constant, with periods of increasing or decreasing intensity. Pancreatic dysfunction occurs when injury to the pancreas results in the inability of the pancreas to make the enzymes necessary to help you digest foods or regulate your blood sugar. Symptoms that result from this dysfunction include fatty diarrhea and/or diabetes.
There are several different causes of chronic pancreatitis. Alcohol abuse has historically been thought to be the most common cause of chronic pancreatitis. Only 5-10% of people who abuse alcohol will develop chronic pancreatitis and so there seems to be several other important factors that contribute to the condition. Likewise, there is considerable variation in individual sensitivity to the toxicity of alcohol and so it is difficult to say what is considered a “safe” level of consumption.
Smoking also has been shown to have an association with chronic pancreatitis, however this association is not as strong as alcohol.
There are several genetic and hereditary conditions that are known to increase the likelihood of developing chronic pancreatitis.
Unfortunately, there are many instances where we never fully know the exact cause of a patient's chronic pancreatitis.
The diagnosis of chronic pancreatitis can be challenging because blood work and imaging tests may be normal, especially early in the disease process. Eventually, as the condition progresses, changes in the pancreas can be seen on CT scan or endoscopic ultrasound that suggest the diagnosis. The presence of diabetes and fatty diarrhea help make the diagnosis but these often do not occur until very late in the process of the disease.
Initial treatment of chronic pancreatitis should be medical, not surgical. Regardless of whether alcohol or smoking caused the chronic pancreatitis, both should be stopped, as they can both make the condition worse. For patients with fatty diarrhea or diabetes, there are medicines that can replace the function of the pancreas and help with the digestion of food and regulation of blood sugar. Another large component of treatment is pain management. This can be done with oral medication but if severe enough, interventional procedures can be performed to numb the nerves around the pancreas and decrease the pain associated with chronic pancreatitis.
Surgery for chronic pancreatitis is often only considered if non-surgical (medical) treatment has failed. The type of surgical procedure depends on several factors but most notable are what part of the pancreas is involved with the disease and is the pancreatic duct dilated. Surgery then involves principles of resection, decompression and/or denervation.
TriHealth is a high-volume center for pancreatic surgery and TriHealth surgeons are experts in the surgical management of chronic pancreatitis. Many of these procedures can be performed using the minimally invasive robotic surgical technique. By making smaller incisions, patients recover quicker and have less complications.