Fact-sheet: Chronic pancreatitis


Updated on 03/18/2024 at 9:27 AM

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Definition

Chronic inflammation of the pancreas resulting in impairment of the endocrine and exocrine functions of the pancreas

Etiologies:

  • Toxic (Alcohol)
  • Obstructive (Cholelithiasis, tumor)
  • Genetic: CFTR, SPINK1, PRSS1 gene mutations (to be investigated if onset before age 35)
  • Autoimmune
  • Idiopathic

Clinical features

Chronic pain triggered by food intake or alcohol consumption

Acute pancreatitis flare-ups

Malabsorption (exocrine deficiency), diabetes (endocrine deficiency), jaundice (if biliary tract obstruction)

CT

  • Main pancreatic duct (MPD) dilation >4mm
  • Pancreatic calcifications
  • Parenchymal atrophy (anteroposterior diameter of the body <2cm) - or pancreatic swelling
  • Pancreatic pseudocysts
  • Irregularities of the main pancreatic duct

MRI

Most sensitive examination

  • Loss of pancreatic signal on T1 FatSat
  • Flame-shaped dilation of the side branches
  • Main pancreatic duct (MPD) dilation >4mm
  • Pancreatic calcifications
  • Intraductal calcifications
  • Parenchymal atrophy (anteroposterior diameter of the body <2cm) - or pancreatic swelling

Management

Etiologic treatment (alcohol cessation)

Classification

Cambridge classification

Grade 0: Normal

Grade 1, Equivocal:

  • Normal MPD
  • Side branch dilation < 3

Grade 2, Mild disease:

  • Normal MPD
  • Side branch dilation >=3

Grade 3, Moderate disease:

  • Dilated MPD
  • Side branch dilation >=3

Severe disease:

  • Dilated, irregular MPD + calcifications and/or pseudocyst
  • Side branch dilation >=3

Differential diagnosis

In cases of idiopathic chronic pancreatitis, rule out cystic fibrosis