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Feature Article

Current approaches to acute and chronic pancreatitis

Jeremy S Wilson, Darren Pavey, Romano C Pirola, Minoti V Apte

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Abstract

Acute pancreatitis is painful but usually self-limiting, and typically caused by gallstones. Chronic pancreatitis can lead to persistent pain and pancreatic insufficiency, and often follows prolonged alcohol misuse although other causes are now recognised.

Key Points

  • Acute pancreatitis presents with severe abdominal pain and raised serum amylase or lipase levels; the most common cause is gallstone disease.
  • Chronic pancreatitis leads to chronic pain, maldigestion and diabetes; the most common cause is prolonged alcohol misuse, but genetic, autoimmune and other forms also occur.
  • The most useful diagnostic imaging techniques are abdominal ultrasonography and CT for acute pancreatitis, and magnetic resonance cholangiopancreatography for chronic pancreatitis.
  • Mild acute pancreatitis usually requires supportive care only, but severe cases require intensive care and combined medical, surgical and endoscopic treatment.
  • Mainstays of treatment of chronic pancreatitis are pain control, pancreatic enzyme supplementation and diabetes control with insulin and diet.

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