Chapter 12 CHRONIC PANCREATITIS
AETIOLOGY AND PATHOGENESIS
The most common cause of chronic pancreatitis in Western nations is alcohol abuse (Table 12.1).
TABLE 12.1 Causes of chronic pancreatitis
Alcohol
Alcohol accounts for 70%–90% of all cases of chronic pancreatitis in Western societies. The onset of alcoholic pancreatitis usually occurs in the fourth decade, and the majority of patients are males consuming alcohol in the order of 100–150 g/day (i.e. 10–15 standard drinks/day) in the 5–15 years prior to initial presentation. Typically, the initial clinical presentation of alcohol-mediated pancreatic injury is acute pancreatitis. However, the characteristic histological and radiological features of chronicity (atrophy, fibrosis and calcification) are already evident in a large proportion of these patients on initial presentation.
Cystic fibrosis
There is a correlation between the degree of abnormal CFTR function and severity of cystic fibrosis. Exocrine pancreatic insufficiency occurs in approximately 85% of patients with cystic fibrosis due to defective secretory capacity of bicarbonate and digestive enzymes. Chronic pancreatitis and pancreatic atrophy arises from inspissated protein-rich acinar secretions that obstruct the ducts resulting in cellular destruction and fibrosis.
ASSESSMENT
History and examination
Steatorrhoea and diarrhoea
Pancreatic exocrine insufficiency may occur as early as 5–6 years after disease onset. Maldigestion may occasionally occur in the absence of abdominal pain. Steatorrhoea occurs in approximately 30% of patients with chronic pancreatitis, and a history of the passage of ‘oil’ at defecation is virtually pathognomonic of pancreatic steatorrhoea. The degree of steatorrhoea depends on the amount of fat ingested.
