Chronic Pancreatitis

The pancreas is an accessory organ of digestion known to have dual functions in the endocrine and exocrine systems. It is necessary for the hydrolysis of macromolecules including proteins, carbohydrates, and fats (in combination with bile from the common bile duct). The pancreas has a main pancreatic duct running through the length of it, an accessory duct, and many various cell types. The ducts can become blocked, or they can be genetically deformed. During constant inflammation, scarring and fibrosis of the ducts lead to permanent damage to many structures, impairing its secretory functions. Chronic pancreatitis is a progressive inflammatory disease of the pancreas that affects both functions of the pancreas. For example, when the exocrine function is affected, patients will present with pancreatic insufficiency, steatorrhea, and weight loss. Pancreatic insufficiency results when greater than 90% of the organ is damaged. The incidence depends on the severity of disease and can be as high as 85% in severe chronic pancreatitis. On the other hand, impairment of the endocrine function of the pancreas will eventually result in pancreatogenic diabetes (Type 3c diabetes). Chronic pancreatitis is unlike acute pancreatitis. The latter presents with acute onset abdominal pain radiating to the back. Patients with chronic pancreatitis may be asymptomatic for long periods of time. At other times, they may also have unrelenting abdominal pain with breakthrough pain requiring hospitalization. This disease process varies from acute pancreatitis in another way, in other words, histologically. The types of inflammatory cells present are different. Acute pancreatitis has a predominance of neutrophils, while chronic pancreatitis has more mononuclear infiltrates.