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This is an introduction to the Gut tutorial “Chronic pancreatitis: diagnosis and management of complications” hosted on BMJ Learning—the best available learning website for medical professionals, from the BMJ Group.
Chronic pancreatitis is a progressive inflammatory condition that leads to irreversible loss of pancreatic structure and function. Eighty percent of cases are due to alcohol misuse. Chronic pancreatitis usually presents with abdominal pain, followed at a variable interval by the features of exocrine and endocrine dysfunction. Clinically significant nutritional deficiencies are not evident until 90% of exocrine function is lost. The majority of pancreatic function tests have a low sensitivity in early disease. In addition to pain, malabsorption and diabetes, chronic pancreatitis has a number of local complications including pseudocyst formation, biliary and duodenal obstruction, venous thrombosis and formation of pseudoaneurysm. Chronic pancreatitis has also been reported to be an independent risk factor for the development of pancreatic cancer, with a cumulative risk of 4% after 20 years of disease, regardless of cause. There is still too often an assumption that little can be done other than to provide analgesia and encouragement to avoid alcohol. Endoscopic cyst puncture is increasingly guided by endoscopic ultrasound and is technically successful in 80‐95% of patients. Surgery for a pancreatic pseudocyst is indicated in the presence of varices and venous thrombosis, situations in which endoscopic drainage may be difficult or impossible. Persistent or progressive biliary stricturing, particularly in the presence of recurrent cholangitis, and the development of secondary biliary cirrhosis is an indication for surgical bypass. Hepatic fibrosis may be reversible following biliary drainage in such patients.
To access the tutorial (Interactive Case History), click on “BMJ Learning: Take this module” on BMJ Learning from the content box at the top right and bottom left of the online article. For more information please go to: http://gut.bmj.com/tutorials/collection.dtl
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