Diabetes and pancreatic cancer management of patients with chronic pancreatitis. Diabetes and pancreatic cancer. Endocr Relat Cancer. Pancreatogenic diabetes: special considerations for management.
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Defining the role of smoking in chronic pancreatitis [Editorial]. Clin Gastroenterol Hepatol. The recurrence of acute alcohol-associated pancreatitis can be reduced: a randomized controlled trial. Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship. Alcohol consumption in patients with acute or chronic pancreatitis.
Stevens T, Conwell DL. Chronic pancreatitis. Cleveland Clinic Center for Continuing Education. Available online. Nat Genet. Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis. Arch Intern Med. Also from ACP, read new content every week from the most highly cited internal medicine journal. Visit Annals.
In many cases, lifestyle changes that slow the progression of chronic pancreatitis will also alleviate pain. Causes The Cleveland Clinic, through its Center for Continuing Education's Disease Management Project, published guidance on chronic pancreatitis for practicing physicians, which states that chronic alcohol abuse is the leading culprit behind chronic pancreatitis. Pain management In many cases, lifestyle changes that slow the progression of chronic pancreatitis will also alleviate pain, said Frank G.
Nutrition Measures to prevent vitamin and mineral deficiencies are part and parcel of treating patients with chronic pancreatitis, said Dr. Complications and cancer Although complications of chronic pancreatitis such as pseudocysts, biliary and gastric outlet obstructions, and pancreatic duct disruption are typically treated surgically, the experts agree that internists should be on the lookout for worsening symptoms of chronic pancreatitis that may suggest these complications, such as increased or unresponsive pain or changes in the type of pain experienced.
Additional reading Banks PA. Scope of Practice. Ultimately, they are eliminated with the stool. Dr Raimondo told IMWR that treatment choices are limited, and "the preparations currently available on the market are from porcine pancreases.
It looks like it is an ideal lipase. This oral drug, ALTU Altus Pharmaceuticals , is an enzyme replacement therapy for patients with malabsorption caused by pancreatic insufficiency. The only known adverse effects are colonic strictures. Video Series. June 3, Laszlo Dosa.
A small number of people may report that their pain decreases as the condition progresses, a phenomenon referred to as burn-out. Other symptoms of chronic pancreatitis can include: [3] [4]. For some people with chronic pancreatitis, the first noticeable symptoms may actually be caused by complications rather than the condition itself. The pancreas produces enzymes which aid digestion. If a person has chronic pancreatitis, the pancreas may become so damaged that it cannot produce enough enzymes to absorb nutrients from food.
This can lead to a condition called malabsorption , which causes symptoms of: [3] [7]. The pancreas also produces insulin, which is important for regulating blood sugar. If the pancreas is damaged to the extent that it can no longer produce enough insulin , a person with chronic pancreatitis may develop diabetes.
Around 6 percent of people with chronic pancreatitis develop a blockage in their bile duct , and 1 to 2 percent will develop a blockage in their small intestine. Both conditions can cause pain, nausea and vomiting, while a blocked bile duct can also cause jaundice. Both conditions may need a surgical bypass. Pancreatic pseudocysts develop in 20 to 40 percent of people with chronic pancreatitis, rising to up to 64 percent in people with alcohol-caused chronic pancreatitis.
A pseudocyst is a sac filled with pancreatic enzymes, tissue and blood. They form when ducts in the pancreas become blocked. Pseudocysts may become infected, rupture or press on nearby organs. Symptoms of pseudocysts include: [11] [12] [13]. A leaking pseudocyst makes it more likely to develop ascites. Pancreatic ascites is the name for a buildup of fluid in the abdominal cavity that surrounds the stomach, intestines and liver. It causes abdominal pain and tenderness, a distended abdomen and weight loss.
Pancreatic enzymes leaking into the abdominal cavity can directly damage body tissue. Up to 45 percent of people with chronic pancreatitis develop a blood clot in the vein of the spleen.
This can lead to internal bleeding and the spleen may need to be surgically removed. Other complications may develop with the spleen because of leaking pancreatic enzymes, owing to the proximity of the spleen and pancreas.
These complications include: [15] [16] [17]. People with chronic pancreatitis, particularly post-menopausal women, men over 50 years old and people who also have malabsorption are at risk of developing problems with their bones. Osteopenia and osteoporosis are conditions that are at increased likelihood of developing. Chronic pancreatitis increases the risk of developing pancreatic cancer.
However, most people with chronic pancreatitis will not develop pancreatic cancer. Chronic pancreatitis occurs when there is damage to the pancreas that does not heal or improve. There are several causes of chronic pancreatitis. Repeated heavy alcohol use accounts for around 50 percent of chronic pancreatitis cases in the United States. More men than women develop alcohol-related pancreatitis. Using tobacco products is also a risk factor for chronic pancreatitis.
Genetics may be a cause of some cases of chronic pancreatitis. Around 85 to 95 percent of people with cystic fibrosis will develop some form of pancreas condition , including scarring of the pancreas which can lead to chronic pancreatitis.
Autoimmune conditions, where the immune system attacks its own body, such as rheumatoid arthritis, hypothyroidism and sclerosing cholangitis - a rare chronic liver condition - can cause chronic pancreatitis, as can certain genetic mutations.
The most common symptoms of autoimmune pancreatitis are jaundice, weight loss and mild pain. Severe pain is unusual in autoimmune pancreatitis. Other causes of chronic pancreatitis include: [4]. Chronic pancreatitis can be difficult to definitively diagnose, particularly in the early stages. People with the condition often present with symptoms caused by complications, such as weight loss, pain or greasy stools. Imaging tests and tests for pancreatic function can diagnose chronic pancreatitis, but the results may not point to a conclusive diagnosis in the early stages.
Diagnosis will start with taking a medical history and a physical examination. Blood tests may be performed which can also be used to identify or exclude other potential causes for the symptoms, such as problems with the gallbladder or bile duct. There are various imaging tests for chronic pancreatitis that can provide information about inflammation, scarring and other damage:.
CT Scan detects changes to the pancreas such as calcification, changes to pancreatic ducts or pseudocysts.
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