Chronic pancreatitis is an inflammatory condition which can ultimately affect both the exocrine and endocrine functions of the pancreas.

Pathophysiology

in many cases, the evolution of the disease is dependent on the complex interaction of gene–gene and gene–environmental factors.

Around 80% of cases are due to alcohol excess with up to 20% of cases being unexplained.

Other than alcohol, causes include:

• ductal obstruction: tumours, stones, structural abnormalities including pancreas divisum and annular pancreas
• genetics:
  • cystic fibrosis - CFTR on the apical surface of acinar cells maintains high volume secretions -flushing trypsin into the duodenum
  • haemochromatosis
  • The SPINK-1 gene is a specific trypsin inhibitor co-secreted with trypsinogen by the acinar cells, Loss-of-function mutations of the SPINK-1 gene have been associated with the development of chronic pancreatitis
• Autoimmune chronic pancreatitis

It involves longer-term inflammation and symptoms with a progressive and permanent deterioration in pancreatic function.

Risk factors:

• Alcohol
• Smoking
• Family Hx
• Coeliac disease
• Psoriasis

PC

Key diagnostic factors: