Pancreatitis chronic K86.1

Progressive inflammatory disease of the pancreas, which in most cases is triggered by long-term alcohol consumption. The clinical picture can progress either in episodes or continuously, even after the original initiating cause has been eliminated. Ultimately, the disease can lead to permanent functional failure of the organ.

Classification of chronic pancreatitis:

• with focal necrosis
• with segmental/diffuse fibrosis
• calcifying

Chronic pancreatitis occurs in 8 out of 100,000 people per year.

Chronic alcohol abuse (about 80%)

Idiopathic (15%)

Other rather rare causes

Medications: Diuretics, ACE inhibitors, beta blockers, methyldopa, estrogens, glucocorticoids, antibiotics, NSAIDs, ciclosporin A, cytostatic drugs such as azathioprine, mercaptopyrine, etc.

Hypertriglyceridemia

Hyperparathyroidism

Hereditary pancreatitis: (mutations in genes:

PRSS1 (encodes cationic trypsinogen; most common form),

• CTRC (encodes for the chymotrypsinogen C),
• SPINK1 (encodes for the serine protease inhibitor, Kazal type1),
• CFTR (encodes Cystic Fibrosis Transmembrane Conductance Regulator).
• Autoimmune pancreatitis (AIP) about 2% of cases of chronic pancreatitis.

The clinical picture of chronic pancreatitis is characterized by various symptoms. These include recurrent but not colicky pain, food intolerance to fat, insulin deficiency diabetes and maldigestion.

Threshold dependent increase of pancreatic enzymes in serum: lipase, elastase1 (specific), amylase (low specificity). Detection of exocrine pancreatic insufficiency (determination of pancreatic elastase in stool).

The diagnostic procedure includes the detection of a pancreatic episode, an etiological clarification and a test of pancreatic functions. Imaging techniques are also used.

The differential diagnosis is acute recurrent pancreatitis, pancreatic carcinoma and diseases such as cholelithiasis and margin carcinoma.

Chronic pancreatitis can lead to stenosis of the pancreatic duct system and the distal ductus choledochus, a thrombosis of the spleen and portal vein and pancreatic pseudocysts.

Among other things, causal therapy treats alcohol abuse. A symptomatic therapy approach can be divided into conservative, endoscopic and surgical treatment. The conservative therapeutic approach treats inflammatory relapses, excretory and endocrine pancreatic insufficiency, pancreatic pain.
An endoscopic therapeutic approach treats pancreatic duct stones and stenoses as well as pancreatic pseudocysts and abscesses. Surgical intervention is performed in the case of partial resections of the pancreas and drainage operations.