Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. The causes of relapsing chronic pancreatitis are similar to those of acute pancreatitis, though gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and more cases of chronic pancreatitis are of undetermined or idiopathic origin.
Patients with chronic pancreatitis can present with persistent abdominal pain or steatorrhea (diarhhea resulting from malabsorption of the fats in food, typically very bad-smelling and equally hard on the patient), as well as severe nausea. Patients with chronic pancreatitis often look very sick.
Among American adults, chronic pancreatitis most often occurs from the cumulative pancreatic destruction caused by repeated alcohol-induced episodes of acute pancreatitis. Cystic fibrosis is the most common cause of chronic pancreatitis in children. In up to one quarter of cases, no cause can be found. In other parts of the world, severe protein-calorie malnutrition is a common cause.
The abdominal pain can be very severe and require high doses of analgesics. Disability and mood problems are common, although early diagnosis and support can make these problems manageable.
Serum amylase and lipase may well not be elevated in chronic pancreatitis. Pancreatic calcification can often be seen on X-rays.
Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Replacement pancreatic enzymes have proven somewhat effective in treating the malabsorption and steatorrhea.
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