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Chronic pancreatitis is a chronic condition in the pancreas. The pancreas is also the digestive – exocrine gland, because it secretes digestive enzymes, and the endocrine – endocrine gland, produces hormones, including the most important hormone regulating blood sugar – insulin.
The pancreas lies in the epigastrium, in the retroperitoneal space, mainly on the left side, in the back of the abdominal cavity. In humans, it consists of the head, covered by the duodenal loop, as well as the body and tail extending into the vicinity of the spleen cavity and the left kidney. In a healthy person, the pancreas weighs 70-100 g, is 12-20 cm long, 4-5 cm high and 2-3 cm thick.
Hormones secreted by the pancreas enter the blood directly, while the pathways that discharge pancreatic juice, which is a product of the exocrine pancreas, leave as the main pancreatic duct (Wirsung duct) on the greater duodenal papilla (Vater’s papilla), most often connecting there with the bile ducts (bile duct). common). It is possible that there may be an accessory pancreatic duct (Santorini duct) that either enters the duodenum on the smaller duodenal papilla or connects to the Wirsung duct.
Two faces of the pancreas
The cells that make up the hormone-producing part of the pancreas are gathered in clusters known as the pancreatic islets or islets of Langerhans. The number of islands is estimated at 1-3 million, and they account for only about 2% of the country’s population. the total mass of this organ.
The Langerhans Islands are made up of:
- B (beta) cells – produce insulin (enables the cells to use sugars and store excess carbohydrates in the liver);
- A (alpha) cells – they produce glucagon (an insulin antagonist that raises blood sugar levels by activating insulin stores as glycogen in the liver);
- delta cells – they produce somatostatin, which acts as a local factor that inhibits the release of hormones (auto-regulation of hormone secretion).
In addition, the pancreas secretes two more hormonal substances – gastrin, which stimulates the secretion of gastric juice, the secretory activity of the gallbladder and the secretion of pancreatic enzymes, and pancreatic peptide.
The exocrine pancreas produces pancreatic juice with numerous proteolytic enzymes that digest proteins (trypsin, chymotrypsin, and erepsin), break down nucleic acids (nuclease, ribonuclease, and deoxyribonuclease), and eventually digest collagen (elastase), as well as lipase digesting fats and carbohydrases.
Pancreatitis – causes
It is not entirely clear whether chronic pancreatitis is a natural consequence of recurrent episodes of acute pancreatitis or whether they are separate diseases. Both forms of pancreatitis gradually damage the pancreas so that it eventually becomes unable to secrete enough hormones and enzymes.
The most common diseases of the pancreas are: acute pancreatitis, chronic pancreatitis, pancreatic cancer (exocrine part) and endocrine neoplasms (isletomas), pancreatic duct stones, pancreatic cysts. Systemic diseases such as diabetes and cystic fibrosis can also cause pancreatic insufficiency, but are not considered diseases of this organ. Gastroenterologists deal with pancreatic diseases.
Chronic pancreatitis – symptoms
Chronic pancreatitis is a disease provoked by inflammatory processes in the pancreas. Chronic pancreatitis is more common in men and is usually caused by alcohol abuse. Sometimes they are caused by gallstones.
The main symptom of this condition is chronic abdominal pain which may spread to your back. It is often accompanied by loss of appetite, weight loss and diarrhea. Pain usually lessens over time as long as you abstain from alcohol.
Chronic pancreatitis is usually diagnosed by ultrasound or endoscopy (ERCP). Sometimes a diagnosis can be made on the basis of an X-ray.
This disease is treated with painkillers. If diarrhea occurs (caused by poor digestion of food), pancreatic enzyme supplementation is used. You should also avoid alcohol.
Sometimes, if the pain is severe and does not go away with treatment, surgery may be needed to remove part of the pancreas. In over 30 percent Diabetes mellitus develops in patients with chronic pancreatitis who abuse alcohol.
It’s not one problem
People suffering from chronic pancreatitis require the care of an interdisciplinary team of specialists, consisting of an experienced gastroenterologist, diabetologist and surgeon. Consultations of a psychiatrist or psychologist may also be indispensable. Every year, chronic pancreatitis (CP) is diagnosed in several to several dozen people per one hundred thousand inhabitants. The most common form is chronic pancreatitis with calcification, the main etiological factor of which is alcohol. The risk of CP increases when we systematically drink even small doses of alcohol – 20 g of pure ethanol per day. This indicates that PPL can develop from the consumption of small, socially acceptable amounts of alcohol. In the case of the less frequently found obstructive CP, tumors of the head of the pancreas and Wirsung’s duct are a frequent cause of inflammation. By removing the cause or mitigating its impact, the scope of the therapy can be determined. Non-pharmacological treatment includes the prohibition of drinking alcohol and the use of a high-calorie diet with a fat restriction of up to 100 g per day.
Chronic pancreatitis – drug treatment
Treatment for chronic pancreatitis is by taking pancreatic enzymes. In 75 percent patients are diagnosed with disturbances in carbohydrate metabolism. If the disease develops as a result of alcohol abuse, secondary diabetes mellitus occurs. Impaired fasting glucose, and especially impaired glucose tolerance, is much less frequent. Most patients fail to achieve improvement in their health and diabetes control through diet. The patient needs to take insulin. In addition to secondary diabetes mellitus, patients with chronic pancreatitis may develop either type 2 or type 1 diabetes. If pharmacological treatment fails, endoscopic surgery may be necessary. This may be a pancreatic fincterectomy, supplemented with stenting or balloon expansion, removal of pancreatic stones, pseudocyst drainage to the stomach or duodenum. Persistent pain and progressive wasting of the body is an indication for surgical treatment. Removal of the head of the pancreas along with part of the duodenum and part of the stomach brings good results.