Virginia Mason gastroenterologists, surgeons, medical oncologists, interventional radiologists and others have achieved international acclaim for treating diseases and disorders of the pancreas. Chronic pancreatitis is severe inflammation of the pancreas marked by intense pain in the upper abdomen. It is commonly caused by long-term alcohol consumption but also may be caused by a blocked pancreatic duct, trauma to the abdomen, a pseudocyst, cystic fibrosis, medications, high levels of calcium in the blood, or from a hereditary or congenital condition. It also may develop after several attacks of acute pancreatitis that damage the pancreas. Chronic pancreatitis is a serious, life-threatening condition requiring immediate medical attention. For more information or to schedule an appointment, call (206) 223-2319.
The majority of chronic pancreatitis cases (about 70 percent) are caused by long-term alcohol use. Chronic pancreatitis is more common in men than women, often developing between the ages of 30 and 40.
Symptoms associated with chronic pancreatitis are similar to those seen in acute pancreatitis, the most common of which is sudden pain in the upper abdomen. The pain is often worse when lying down but may feel less intense when sitting up or bending over.
Other symptoms include:
- Rapid pulse
- Pain radiating from abdomen to the back or chest
- Abdomen tender to the touch
- Distended (bloated) abdomen
The intense pain associated with chronic pancreatitis occurs because digestive enzymes that are normally released into the small intestine remain within the pancreas and attack the pancreas instead. Pancreatitis also affects the pancreas' ability to release insulin that is needed to regulate the body's glucose (sugar) levels. In a worse case scenario, pancreatic tissue can die and become infected (pancreatic necrosis or abscess).
Your gastroenterologist may suspect chronic pancreatitis based on your medical history and your signs and symptoms. The same tests and procedures used to diagnose acute pancreatitis are used to diagnose chronic pancreatitis.
Your blood may be tested for abnormal levels of pancreatic enzymes that aid in digestion.
This non-invasive procedure uses sound waves rather than X-rays to produce images. The images can reveal the presence of blockages within the biliary tract. During this procedure, an ultrasound probe is passed over the abdomen and images are sent to a computer monitor.
ABDOMINAL CT SCAN OR MRI
A CT scan or MRI of the abdomen also can identify blockages within the biliary system. Both scans are noninvasive procedures, during which the bile duct images are shown on a computer monitor.
ERCP WITH ENDOSCOPIC ULTRASOUND
Endoscopic retrograde cholangiopancreatography, or ERCP, is a specialized endoscopic technique used to study the gallbladder, pancreas and bile ducts, and has the added benefit of being a therapeutic tool. ERCP has been in use for more than 30 years, and is considered the standard modality for diagnosing and treating disorders of the biliary tract.
During ERCP, patients first receive an anesthetic to numb the throat along with a mild sedative. Your gastroenterologist will then pass a small flexible endoscope with a miniature TV camera inside through your mouth and into the stomach and small intestine. When your gastroenterologist sees the bile and pancreatic ducts on a monitor, he or she will pass a thin ultrasound probe through the ERCP. Endoscopic ultrasound (EUS) uses ultrasound images in place of X-rays for better viewing of the bile and pancreatic ducts.
Special preparations are required for this endoscopic procedure.
Magnetic resonance cholangiopancreatography is newer technology being employed at Virginia Mason. This noninvasive diagnostic procedure is performed in Radiology using MRI technology (magnets and radio waves) to produce computer images of the bile ducts. A contrast dye is injected first through the abdominal skin to enhance the images. Patients are not required to undergo endoscopy preparation and they do not undergo sedation. MRCP is being used primarily in patients who may have failed or who are not good candidates for ERCP, in those who do not want to undergo an endoscopic procedure, and in individuals considered to be at low risk of having a pancreatic duct or bile duct disorder. While ERCP allows for therapeutic options with cholangioscopy, MRCP is a diagnostic tool only.
Patients with chronic pancreatitis spend often several days to several weeks in the hospital, depending upon the severity of the disease. Patients may receive antibiotics, intravenous fluids, pain relievers and other medications as needed. Patients do not eat solid meals or drink fluids for a period of time so that the pancreas has time to heal.
Patients with chronic pancreatitis usually have more damage to their pancreas and require more therapy over a longer period. The cause of chronic pancreatitis and the amount of damage to the pancreas will guide your physicians' treatment decisions.
If the cause of chronic pancreatitis is identified as a narrowing or blockage of the bile or pancreatic duct, a bile duct leak, or a pseudocyst, all of these conditions can be treated by our Advanced Therapeutic Endoscopy team with endoscopic retrograde cholangiopancreatography or ERCP.
These procedures include enlarging the duct, placing a stent (a hollow tube) to keep the duct open, performing a sphincterotomy and stent placement to treat a bile duct leak, and draining or removing a cyst.
Preventive measures for a recurring attack also are advised for patients and include avoiding smoking and alcoholic beverages, and refraining from eating a high-fat diet.
Our surgeons offer the full spectrum of open and laparoscopic/minimally invasive surgical options using state of the art techniques for patients with chronic pancreatitis, strictures and cysts.