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Pancreatitis, whether acute or chronic, is a complex and multifaceted disease that requires a comprehensive and multidisciplinary approach for effective management. Advances in understanding the pathophysiology and improved diagnostic and therapeutic strategies continue to enhance patient care and outcomes.
Pancreatitis is an inflammatory condition of the pancreas that can manifest in acute or chronic forms. This article explores the definitions, causes, symptoms, diagnosis, and treatment options for both acute and chronic pancreatitis.
Acute Pancreatitis
Definition
Acute pancreatitis (AP) is an acute inflammatory process of the pancreas characterized by severe abdominal pain, elevated pancreatic enzymes, and changes in pancreatic structure visible on imaging3 4 6.
Causes
The most common causes of acute pancreatitis include gallstone migration into the common bile duct and alcohol abuse. However, about 15-25% of cases are of unknown origin8 10.
Symptoms
The primary symptom of acute pancreatitis is acute abdominal pain. Other symptoms include elevated serum amylase and lipase levels, which help confirm the diagnosis8.
Pathophysiology
Acute pancreatitis involves injury to the pancreatic acinar cells and subsequent activation of inflammatory pathways. This can lead to local pancreatic damage and systemic inflammatory response syndrome (SIRS), which may result in organ failure4 6.
Diagnosis
Diagnosis is typically based on clinical presentation, elevated pancreatic enzyme levels, and imaging studies such as CT or MRI7 8.
Treatment
Treatment of mild acute pancreatitis is generally supportive, involving pain management and nutritional support. Severe cases require a multidisciplinary approach, including gastroenterologists, radiologists, intensivists, and surgeons7 8. Early enteral nutrition has been shown to be beneficial in managing acute pancreatitis3.
Chronic Pancreatitis
Definition
Chronic pancreatitis (CP) is a long-standing inflammatory condition of the pancreas that leads to irreversible damage, fibrosis, and loss of both exocrine and endocrine functions1 2 5.
Causes
Chronic pancreatitis can be caused by a variety of factors, including toxic-metabolic factors (e.g., alcohol and smoking), genetic predispositions, autoimmune responses, and recurrent episodes of acute pancreatitis1 5 9.
Symptoms
The most common symptom of chronic pancreatitis is persistent abdominal pain. Other symptoms include exocrine pancreatic insufficiency, leading to maldigestion, and endocrine insufficiency, resulting in diabetes mellitus1 5.
Pathophysiology
The pathophysiology of chronic pancreatitis involves complex mechanisms such as acinar cell injury, ductal dysfunction, and persistent inflammation. These processes lead to fibrosis and loss of pancreatic tissue1 2.
Diagnosis
Diagnosing chronic pancreatitis, especially in its early stages, is challenging. Imaging studies such as CT, MRI, and endoscopic ultrasound are commonly used. Functional tests may also be employed to assess pancreatic exocrine function2 5.
Treatment
Management of chronic pancreatitis requires a multidisciplinary approach, including pain management, nutritional support, and treatment of exocrine and endocrine insufficiencies. Pancreatic enzyme replacement therapy and lifestyle modifications, such as cessation of smoking and alcohol consumption, are essential components of treatment2 5 9.