Having the Best Support & Care for Chronic Pancreatitis

• Biochemical Measurements: People with chronic pancreatitis may have low or elevated levels of isoamylase, trypsin, lipase, and elastase. In cases with mild chronic pancreatitis, it is difficult to make a definitive diagnosis based on serum enzyme levels alone.
• Radiological Testing

• Plain Abdominal Film: An abdominal film is usually the first diagnostic test used to establish a diagnosis of chronic pancreatitis. Diffuse, speckled calcification of the gland may suffice as a positive finding
• Transabdominal Ultrasound: This is a simple, noninvasive, and relatively inexpensive imaging technique. Findings of a dilated pancreatic duct (greater than 4 mm), calcification, and large cavities (greater than 1 cm) are associated with chronic pancreatitis (70% sensitivity and 90% specificity)
• Computed Tomography (CT): More sensitive than transabdominal ultrasound, CT (computed tomography) scanning can demonstrate duct dilation, cystic lesions, and calcification. This technique is useful in discriminating chronic pancreatitis from pancreatic carcinoma
• Magnetic Resonance Cholangiopancreatography (MRCP): It represents a major advance in the demonstration of pancreatic ductal anatomy. MRCP yields satisfactory pancreatograms in patients with chronic pancreatitis in whom a CT scan showed no abnormalities
• Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is an endoscopic technique for visualization of the bile and pancreatic ducts. This is a sensitive and specific diagnostic tool in chronic pancreatitis. ERCP shows details of the pancreatic ductal anatomy, including strictures, ductal rupture and pseudocysts
• Endoscopic Ultrasonography (EUS): It is the most sensitive imaging tool for the diagnosis of chronic pancreatitis, and has been proven to be more accurate than the CT scan.

The most important aspects of managing CP involve: (1) amelioration of pain; (2) maintain nutrition and control indigestion and (3) tackle complications.

• Control of abdominal pain: The goal of therapy is to control pain to that level that it may not hamper patient’s life as complete relief of pain is not expected. The following modalities are used to control the pain.

• Analgesics
• Pancreatic Enzymes
• Antioxidants
• Pregabalin
• Nerve Blocks: Celiac plexus blockade (CPB) and celiac plexus neurolysis (CPN) are the nerve block methods used to disrupt the signaling of the pancreatic pain afferents to the spinal cord.
• Endoscopic Therapy: The aim of the endotherapy is to relieve pain by alleviating outflow obstruction of PD and decrease ductal hypertension. Endoscopic pancreatic sphincterotomy has been used to reduce pancreatic duct pressure and to facilitate other procedures such as pancreatic stent placement, tissue sampling, dilation of strictures, or stone removal
• Surgical intervention: Surgical therapy is usually reserved for patients with pain not responding to both medical and endoscopic therapy or in whom endoscopic therapy is difficult like multiple and distal strictures, large, multiple and impacted stones.
• The surgical intervention is aimed at reaching two goals; the removal of the space occupied lesions and the provision of the decompression of the pancreatic duct system; however, the type of surgical intervention has been a matter of debate.