Year: 2012
Type: book-chapter
Abstract: Chronic Pancreatitis 98 lifetime narcotic use (Ahmad et al., 2005;Braganza et al., 2011;Gachago & Draganov, 2008;Mullhaupt & Ammann, 2010).Thus, an appreciation of the spectrum of the disease, the inconsistency in correlation between imaging and gross and microscopic pathology results and the degree of pain, and the various mechanisms by which CP causes pain are relevant for patient selection and for interpretation of the outcomes in the TP-IAT series reviewed here. Brief review of chronic pancreatitis and treatment optionsCP is characterized by progressive, irreversible damage to the pancreas, with varying degrees of inflammation, fibrosis, ductal alteration, exocrine atrophy, and secondary involvement of the islets of Langerhans (Braganza et al., 2011).The clinical manifestations also vary as to the degree of pain, maldigestion from loss of exocrine function, and occurrence of diabetes.Although lost exocrine function can be managed with oral pancreatic enzyme supplements, and diabetes, if it occurs, with insulin, the hallmark of CP is pain, often intractable and debilitating.Pain is the main symptom toward which therapies are directed, all with significant failure rates (Gachago & Draganov, 2008).The acute and chronic forms of pancreatitis are not totally distinguishable.They have overlapping risk factors and share a common pathogenic origin as a pancreatic autodigestive process.Additionally, they each may manifest as an initial episode of abdominal pain, with elevation of serum amylase and lipase, and with similar nonspecific inflammatory changes.CP is likely the result of progressive pancreatic damage after recurrent episodes of pancreatic necro-inflammation.The sentinel acute pancreatitis event (SAPE) hypothesis (Schneider & Whitcomb, 2002), postulates that the sentinel event is a pancreatic injury that makes the gland particularly vulnerable, in the recovery phase, to additional insults such as alcohol, metabolic, and oxidative stresses.ARP may evolve to CP; patients who are initially pain free between episodes may begin to have underlying interval pain and may cease having episodes altogether.Even one episode of acute pancreatitis may be followed by evolution to CP, or CP may occur without a history of an identifiable episode of acute pancreatitis.Whatever the trigger, progression of CP to end-stage fibrosis occurs at different rates in different people, and can be caused by different mechanisms (Etemad & Whitcomb, 2001).
Source: InTech eBooks
DOI: 10.5772/29372
Authors: David E.R., Melena Bellin, Juan J., Greg J., Ty B., Srinath Chinnakotla, Timothy L., Martin L., A.N. Balamurugan, Barbara Bland, David Radosevich, Bernhard J.
Institution: University of Minnesota
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W4253692004