K86.1
DESCRIPTION
Chronic inflammatory condition of the pancreas, which results in functional and structural damage. In most patients, this is a chronic progressive disease leading to exocrine and/or endocrine insufficiency.
GENERAL MEASURES
Abstinence from alcohol reduces abdominal pain in the early stages of the disease.
Stop smoking.
Small frequent meals, and restricted fat intake reduces pancreatic secretion and pain.
Elemental diets (i.e. parenteral or enteral nutrition) in chronically debilitated patients.
When weight loss is not responding to exogenous enzymes and diet, consider supplementation with medium chain triglycerides.
There is a risk of developing cancer of the pancreas. This should be considered in patients who develop worsening pain, new onset diabetes or deterioration in exocrine function.
Dietary advice by dietician.
MEDICINE TREATMENT
Treatment is aimed at:
- pain,
- malabsorption, and
- endocrine function. See Type 1 Diabetes mellitus .
Analgesia
See Pain, chronic .
Note: Pancreatic enzymes may reduce pain by negative feedback on pancreatic secretion.
Malabsorption
Start treatment when >7 g (or 21 mmol) fat in faeces/24 hours while on a 100 g fat/day diet.
Reduce dietary fat to < 25 g/meal.
Supplementation of fat-soluble vitamins may be indicated.
- Lipase, oral, equivalent to lipase 30 000 units per day, in divided doses with meals.
Aim for symptom control and/or 5% of normal faecal fat output.
REFFERAL
Surgical intervention, pseudocyst.
Autoimmune chronic pancreatitis.