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I am Vikesh Singh, I am a Gastroenterologist at Johns Hopkins.
I am the director of the Pancreatitis Center, and I
am the Medical Director of the Eyelid Auto Transplantation Program.
I specialize in inflammatory disorders of
the pancreas, as well as interventional endoscopy.
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Chronic pancreatitis is a long-standing inflammatory disorder of the
pancreas which results in gradual and progressive fibrosis of the gland.
And that ultimately results in 3 common complications which include
chronic abdominal pain exocrine insufficiency,
as well as endocrine insufficiency.
Chronic abdominal pain is the primary reason
that patients seek medical attention for this problem.
However in the later stages of
the diseases, the exocrine insufficiency, which
is typically manifested by voluminous diarrhea,
and endocrine insufficiency which is commonly
know as diabetes often set in, and these are other conditions that
typically need to be managed as part of the care of these patients.
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Acute pancreatitis is a sudden inflammation of
the pancreas, which typically catches people off
guard, and is most commonly manifested by
severe abdominal pain which requires medical attention.
These patients typically present to emergency rooms after the diagnosis
which is based on simple blood tests, and sometimes a CT scan of the abdomen.
These patients are usually admitted, they're kept nothing by
mouth, they're given IV fluids as well as pain medication.
What typically sets apart acute from chronic pancreatitis, is
that acute pancreatitis usually gets better from these conservative measures.
Chronic pancreatitis is really what sets in over a
longer period of time of continuous bouts of acute pancreatitis.
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There aren't any other types of pancreatitis, but there are other
forms of pancreatitis that can result in acute and chronic inflammation.
Probably the one we most commonly think of is autoimmune
pancreatitis where the body itself is attacking the pancreas, and that
leads to not only acute inflammation, but over some period
of time, that can also cause the changes of chronic pancreatitis.
But other than that, there are no other true pathologic forms of pancreatitis.
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The diagnosis of chronic pancreatisis
involves a combination of testing modalities.
One is often the clinical history, but in, in addition to that, the Physician might
employ, a range of tests including simple blood
tests, stool tests, imaging studies, and endoscopic procedures.
Diagnosing moderate or severe chronic pancreatitis is actually very, very easy.
A simple imaging study typically reveals changes in
the gland which are common for chronic pancreatitis.
In the earliest or mild stages of the disease, that
is really where the most difficulties are in diagnosing chronic pancreatitis.
These are the patients who often have abdominal pain that's chronic in nature
and maybe quite debilitating, and even to
the point where they often require narcotics.
However pursuing simple imaging studies in
these patients usually reveals normal pancreas.
It is those patients who I think form the greatest challenge for their providers.
And I think that it's those patients who are probably
best served by being referred to a tertiary center where they
can undergo more complex testing and evaluation in order to figure
out whether they might really have mild or early chronic pancreatictitis.
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