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About chronic pancreatitis
Your pancreas is a 15 centimetres (six inches) long organ which is part of your digestive system. It's found just in front of your spine (back bone), behind your stomach, at the level where the two sides of your rib cage join together. It's connected to the duodenum (small bowel) by a tube called the pancreatic duct.
Your pancreas produces enzymes (digestive juices) which break down food, particularly fatty foods. These digestive juices pass down the pancreatic duct into the duodenum which contains food to be digested. The pancreas also produces insulin - a hormone that helps to keep the level of sugar in your blood constant.
There are a number of symptoms of chronic pancreatitis, including:
- Persistent or recurrent pain around the upper part of your abdomen (tummy) and/or back which may be better when you sit forwards
- Feeling weak
- Jaundice, which is when the whites of your eyes and your skin look yellowed
- Pale, fatty, smelly faeces that are difficult to flush away
- Unexplained weight loss
- Thirst and passing large amounts of urine (diabetes)
- Long-term health problems
What causes chronic pancreatitis?
The most common cause of chronic pancreatitis is long-term excessive alcohol consumption. There is a direct relationship between the amount of alcohol consumed and the risk of developing chronic pancreatitis.
Other causes include:
- High levels of calcium in the blood
- Abnormalities in anatomy which are usually present at birth
- Cystic fibrosis
- High blood fats (hypertriglyceridaemia)
- In rare cases, some drugs can cause pancreatitis
- In a number of cases no specific cause can be identified, a condition known as idiopathic pancreatitis.
Your GP will examine you and ask you about your symptoms. They may take a blood test and refer you to a gastroenterologist, a doctor who specialises in conditions of the digestive system, for tests which may include the following.
- Further blood tests may be taken which will be sent to a laboratory for testing.
- A faeces sample test may be required. This will be sent to a laboratory for testing.
- You may have an abdominal ultrasound which uses high frequency sound waves to produce an image to look for any changes. This is sometimes done using an endoscope.
- A biopsy may be taken from the pancreas with a needle. A biopsy is a small sample of tissue. This will be sent to a laboratory for testing.
- An ERCP (endoscopic retrograde cholangio-pancreatography) is a test where a narrow, flexible, tube-like telescopic camera called an endoscope is guided using ultrasound, to check your digestive system. This procedure can also occasionally trigger an attack of pancreatitis.
Treatment of chronic pancreatitis depends on the cause of the disease, severity of the associated pain and effectiveness of former treatment approaches. The first step of treatment focuses on relieving pain and eating a diet that is high in carbohydrates and low in fat. It is essential to stop drinking alcohol entirely.
Your doctor may prescribe pancreatic enzymes to take with meals if your pancreas does not secrete enough of its own enzymes. The supplemental enzymes should be taken with every meal to help your body digest food and regain some weight. If you have diabetes, insulin and other drugs may be needed to control blood sugar levels.
There are a number of surgical procedures available for patients whose pain is not relieved by medications or other approaches. Surgery may involve removing stones from the pancreas, draining blocked ducts, or partial or entire removal of the pancreas.
A partial pancreatectomy involves removing part of the pancreas, such as the body or tail, during a Puestow or Whipple procedure. A total pancreatectomy involves removing the entire pancreas. While a total pancreatectomy is usually effective in relieving pain in patients when all other treatments fail, it induces permanent diabetes, requiring patients to take insulin shots or use an insulin pump for the rest of their lives. This is because the pancreas contains Islets of Langerhans — also known as islets or islet cells — that regulate the body's blood sugar levels.
UCSF's Islet and Cellular Transplantation Center is one the few medical centers in the country to offer a total pancreatectomy performed with an islet autotransplant. This innovative dual procedure helps alleviate pain caused by pancreatitis, while preserving the ability to secrete insulin and reducing the risk of developing surgically induced diabetes.
Pancreatectomy and Islet Autotransplant
Patients with chronic pancreatitis have the option of having an islet auto (meaning "self") transplant after their total pancreatectomy. During an islet autotransplant, the patient's own islet cells are isolated from their removed pancreas and then put back into the patient, where they start producing insulin.
This procedure may prevent diabetes from developing or make the diabetes milder than if a patient had had a pancreatectomy alone.
While the goal is to eliminate each patient's pain, preserve their pancreatic function and prevent diabetes, there is no guarantee that diabetes will not develop because there is no way of determining the quality of a patient's islets before transplantation.
Patients who have a pancreatectomy with an islet autotransplant have a 50 percent chance of becoming insulin dependant for life, while patients who have only a pancreatectomy have a 100 percent chance of becoming permanently insulin dependant. Patients who are at the highest risk of developing diabetes are those who have not had prior surgery to remove a portion of their pancreas.
Typically, patients spend two to three weeks in the hospital following a pancreatectomy with an islet autotransplant. During this time, patients receive an insulin drip and learn how to manage diabetes in case they develop the condition.
As islets start working, patients are able to reduce the amount of insulin they take. Within a month, it usually becomes clear whether islets are working well enough for patients to completely stop taking insulin. If diabetes develops, it is important that a patient works closely with their doctor to develop an insulin treatment plan.
Signs and tests
Tests for pancreatitis include:
Inflammation or calcium deposits of the pancreas may be seen on:
- Fecal fat test
- Serum amylase
- Serum lipase
- Serum trypsinogen
- Abdominal CT scan
- Abdominal ultrasound
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