Chronic pancreatitis

Patients with acute pancreatitis are at risk of repeated inflammatory episodes which eventually develop into chronic inflammation. The most common cause is alcohol abuse. In other cases, chronic pancreatitis has a gradual onset which does not seem to be associated with previous acute attacks.
The normal pancreatic tissue is progressively replaced by fibrosis, which may encase the nerves in the coeliac plexus, causing abdominal pain, particularly
post-prandially. The patient has fatty stools (steatorrhoea) due to malabsorption, as there is a decreased capacity to produce the digestive
enzymes.
Diagnosis of chronic pancreatitis can be difficult, especially in the early stages.8 Serum enzyme levels are less elevated than in acute disease (if at
all). ERCP, which detects abnormalities of the ductal system in the early stages, is increasingly contraindicated due to the risk of aggravating the
pancreatitis. MRCP is promising, but is limited in assessing the smaller side ducts. Endoscopic ultrasound is currently a sensitive and accurate modality
in assessing both the ductal system and the pancreatic tissue.
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