Chronic Pancreatitis

Overview
  • Chronic Pancreatitis is characterized by a pattern chronic inflammation and fibrosis of the pancreas leading to irreversible damage to the organ.
Etiology
  • Cystic Fibrosis is most commonly associated with development of chronic pancreatitis in children. Alcohol abuse is the most common cause of chronic pancreatitis in adults although the risk does not seem to be a direct correlation with the amount of alcohol consumed indicating that additional genetic or environmental factors are of importance. It should be pointed out that for roughly a quarter of adults who develop chronic pancreatitis there is no history of alcohol abuse. Interestingly, many of these adults carry mutations in the CFTR gene associated with cystic fibrosis. Notably, these adults display no symptomology associated with cystic fibrosis, suggesting that distinct sets of mutations within the CFTR gene can result in distinct clinical consequences.
Pathogenesis
  • The pathogenesis of chronic pancreatitis is extremely obscure. How the above etiologies are connected to chronic inflammation and fibrosis of the pancreas is highly unclear. In the case of patients with CFTR mutations it is possible that CFTR mutations reduce the capacity of the pancreas to secrete fluid and thus wash out secreted zymogens. Accumulation of these zymogens may block pancreatic ducts leading to intermittent bouts of inflammation. In alcohol abusers, the risk of chronic pancreatitis increases with repeated bouts of acute pancreatitis.
Morphology
  • Chronic pancreatitis is characterized by extensive fibrosis of the exocrine pancreas, resulting in disfigurement of the normal pancreatic architecture. A chronic inflammatory infiltrate of mononuclear cells is usually present. Islets of Langerhans of the endocrine pancreas are usually spared but over time may become involved.
Clinical Consequences
  • Patients with chronic pancreatitis typically display episodic and recurrent abdominal pain although there is a wide range in quality and severity. Due to progressive destruction of the exocrine pancreas, many patients will develop malabsorptive steatorrhea. Given the malabsorption and the abdominal pain, which frequently worsens after a meal, many patients will undergo weight loss. While many patients will display glucose intolerance due to progressive destruction of their pancreatic islets, more severe diabetes along with its complications are typically not observed.