Chronic Pancreatitis

THE CLINICAL SYNDROME

Chronic pancreatitis is one result of acute pancreatitis. Chronic pancreatitis may present as recurrent episodes of acute inflammation of the pancreas superimposed on chronic pancreatic dysfunction or as a more constant problem. As the exocrine function of the pancreas deteriorates, malabsorption with steatorrhea and azorrhea develops. Abdominal pain is usually present, but it may be characterized by exacerbations and remissions. In the United States, chronic pancreatitis is most commonly caused by alcohol, followed by cystic fibrosis and pancreatic malignancies. Hereditary causes such as alpha-1 antitrypsin deficiency also are common causes of chronic pancreatitis. In the developing countries, the most common cause of chronic pancreatitis is severe protein calorie malnutrition.

Abdominal pain is a common feature in chronic pancreatitis. It mimics the pain of acute pancreatitis, may range from mild to severe, and is characterized by steady, boring epigastric pain that radiates to the flanks and chest. The pain is worse with alcohol and fatty meals. Nausea, vomiting and anorexia are also common features of chronic pancreatitis, but as mentioned, the clinical symptoms frequently encountered in chronic pancreatitis are characterized by exacerbations and remissions.

SIGNS AND SYMPTOMS

The patient with chronic pancreatitis will present as does the patient with acute pancreatitis but may appear more chronically ill than acutely ill. Tachycardia and hypotension due to hypovolemia are much less common in chronic pancreatitis and if present represent an extremely ominous prognostic indicator or suggest that another pathologic process, such as perforated peptic ulcer, is present. Diffused abdominal tenderness with peritoneal signs may be present if acute inflammation occurs. A pancreatic mass or pseudocyst due to pancreatic edema may be palpable.

Chronic pancreatitis may present in a manner analogous to the presentation of acute pancreatitis, but can be more challenging to treat.

TREATMENT

The initial treatment of patients suffering from chronic pancreatitis should be focused on the treatment of the pain and malabsorption. As with acute pancreatitis, the treatment of chronic pancreatitis is aimed primarily at putting the pancreas at rest. This is accomplished by holding the patient NPO (nothing by mouth) to decrease serum gastrin secretion and, if ileus is present, instituting nasogstric suction. Short acting potent opioid analgesics such as hydrocodone represents a reasonable next step if conservative measures do not control the patient’s pain.

If the symptoms persist, computed tomography guided celiac plexus block with local anesthetic and steroid is indicated and may help decrease the mortality and morbidity rates associated with the disease. If the relief from this technique is short lived, neurolytic computed tomography-guided celiac plexus block with alcohol or phenol represents a reasonable next step. As an alternative, continuous thoracic epidural block with local anesthetic, opioid, or both may provide adequate pain control and allow the patient to avoid the respiratory depression associated with systemic opioid analgesics.

Low intensity laser therapy as well as a coordinated wellness program is also effective in treating this disorder.

Low Intensity Laser Therapy (LILT)

The low intensity Laser (LILT) sends photons (light) into the injured tissues and can penetrate two to three inches to treat affected areas. It uses a natural enhancement of the cellular machinery that can and has been dynamically measured in published studies to promote healing without burning affected tissue .Once the photons find the injured tissues, they stimulate and energize the cells to repair and strengthen at a remarkable rate. The treatment does not hurt, takes about 30 minutes and is very cost advantageous.

Wellness Program

A wellness program whichindividualizes treatment for age, performance and function has been shown in pilot studies to improve the overall health and well being of the individuals evaluated. A well conceived dietary and supplementary regimen based on scientific age–related decline in certain necessary compounds can improve quality of life, correct the ravages of hormone imbalance, balance critical neurotransmitter function without resorting to powerful drugs for depression that often have unfavorable side-effect profiles and restore vitality and youth in daily exercise routines. Furthermore, when wellness products are utilized with success, individuals often seek less costly interventions including unnecessary surgeries and narcotic options to treat pain. For more information go to www.drpwellness.com.