| Abstract: | Chronic pancreatitis (CP) is a progressive, disabling, fibro-inflammatory disease of the pancreas of variable clinical course and is usually associated with permanent loss of exocrine and endocrine function over a period of time. The incidence is increasing. There are various aetiological risk factors that cause CP, chronic alcoholism being the most common risk factor. The TIGAR-O classification identifies all the risk factors and aetiology. Most susceptible patients have a sentinel acute pancreatitis event which initiates chronic progressive inflammation, scarring and fibrosis, though some may present insidiously with symptoms of functional loss – diabetes or steatorrhoea. Intractable abdominal pain, steatorrhoea, weight loss and (type 3c) diabetes mellitus are late manifestations of the disease. Diagnosis is made with a combination of clinical history, examination, cross sectional imaging combined with pancreatic function tests (in equivocal cases). Complications include gastric and biliary obstruction, pseudocyst formation, pancreatic ascites, pseudoaneurysms and venous thrombosis. Patients with CP have increased risk of developing pancreatic adenocarcinoma. Management includes making the diagnosis, identifying the aetiology, instituting life-style changes to abstain from alcohol and smoking, and involving the specialist multidisciplinary team (including pain team, dietician, clinical psychologist, endoscopist, gastrointestinal physician and pancreatic surgeon) if initial steps do not control the symptoms. |
