View source for Chronic pancreatitis

==Clinical Features<ref>Braganza, J. M., Lee, S. H., McCloy, R. F., & McMahon, M. J. (2011). Chronic pancreatitis. Lancet, 377(9772), 1184–1197. doi:10.1016/S0140-6736(10)61852-1</ref><ref>Steer, M. L., Waxman, I., & Freedman, S. (1995). Chronic pancreatitis. New England Journal of Medicine, 332(22), 1482–1490. doi:10.1056/NEJM199506013322206</ref>==
* Pain
** Episodic (1wk) or constant
** Epigastric, radiating to back and left infrascapular region
** Associated with nausea/vomiting
** Improved with sitting up or leaning forward
* Steatorrhea/DM
** Late finding
** Requires >80-90% loss of exocrine and endocrine function
* Erythema ab igne
** Hyperpigmentation of upper abdomen

==Differential Diagnosis==
{{Abdominal Pain DDX Epigastric}}

==Diagnosis==
* Labs
** Lipase: Normal or slightly elevated
** Increased [[Hyperbilirubinemia|bilirubin]], alkaline phosphatase: Associated with compression of intrapancreatic bile duct (10-15%)
** Pancreatic function tests: Secretin stimulation
** Gamma-globulin IgG elevation (IgG4) in autoimmune
* Imaging<ref>Choueiri, N. E., Balci, N. C., Alkaade, S., & Burton, F. R. (2010). Advanced imaging of chronic pancreatitis. Current gastroenterology reports, 12(2), 114–120. doi:10.1007/s11894-010-0093-4</ref><ref>Remer, E. M., & Baker, M. E. (2002). Imaging of chronic pancreatitis. Radiologic clinics of North America, 40(6), 1229–42– v.</ref>
** [[Abd xray|Plain film]]: pancreatic calcifications (30%)
** CT: intraductal calcifications (insensitive for early disease)
** ERCP: gold standard 

==Management==
* Lifestyle modifications (alcohol and tobacco cessation), dietary changes
* Pancreatic enzyme supplements
* Acid suppression (H2-antagonist, PPI)
* Analgesics (NSAID, opioid, pregabalin)
* Specialist referral for refractory pain

==See Also==
* [[Pancreatitis]]
* [[Pancreatitis Guidelines]]

==References==
<references/>

[[Category:GI]]