Chronic pancreatitis

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Chronic pancreatitis is a continuing inflammatory pancreatic disease. The histologic changes in chronic pancreatitis are irreversible and tend to progress, resulting in serious loss of exocrine and endocrine pancreatic function and deterioration of pancreatic structure. However, possible discordance between clinical and histologic components may complicate classification. For example, alcoholic pancreatitis may initially present as acute pancreatitis, clinically but may already be chronic histologically.

The etiology in North America is most frequently due to excessive alcohol consumption (7-% of cases; >80g/day; 6 drinks). Alcohol increases the viscosity of pancreatic juice and decreases pancreatic secretion of pancreatic stone protein (lithostatin), which normally solubilizes calcium salts and leads to the precipitation of calcium within the pancreatic duct. This results in duct obstruction and subsequent gland destruction The rest of the cases are either idiopathic (20%) or "other" (10%).

Pathological findings include irregular sclerosis, destruction of exocrine parenchyma, varying degrees of ductular dilatation and associated ductal strictures, protein plugs, calcification, edema, focal necrosis, inflammatory cells, cysts and pseudocysts and infection.

Clinically, patients present with recurrent attacks of severe abdominal pain (upper abdomen and back) and chronic painless pancreatitis.