Chronic Pancreatitis

In the presence of steatorrhea and Sr. trypsinogen level of <20 ng/mL - is Dxtic of chronic pancreatitis with exocrine insufficiency.

CT with contrast

MRCP

Endoscopic U/S

Tx:

narcotic analgesics. Neuromodulators (SSRIs and TCAs) may improve sx and decrease reliance on narcotics.

Pancreatic enzyme supplements in conjunction with low-fat <50 g fat/d is the mainstay of management of pancreatic exocrine insufficiency. Pancease or Creon, 1 - 2 caps, PO with meals.

Fat-soluble vitamin supplementation may be necessary, while use of antioxidants may improve sx.

Insulin therapy is generally needed for endocrine insufficiency.

Tx underlying d/o such as hyperparathyroidism, dyslipidemia, alcohol cessation.

Stones obstructing pancreatic ducts, strictures, or papillary stenosis may benefit from ERCP and sphincterotomy.

Intractable pain may necessitate celiac ganglion block or even surgery, such as Whipple's procedure.