Chronic pancreatitis
How repeated injury from alcohol, smoking, genes, duct blockage or autoimmunity turns the pancreas into scar and stone, why the pain persists, and why digestion and glucose control fail only once most of the gland is lost.
By the end, you can
- Describe the acini, ducts and islets of the pancreas and how duct cells keep pancreatic juice flowing.
- Explain how alcohol, smoking, genetic variants, duct obstruction and autoimmunity lead from repeated injury to fibrosis, using the sentinel acute pancreatitis event model.
- Explain how protein plugs, calcified stones and duct strictures form, and why the pain has duct, inflammatory and nerve components.
- Relate exocrine failure to steatorrhoea and fat-soluble vitamin loss, and islet loss to type 3c diabetes with a tendency to hypoglycaemia.
- Compare acute and chronic pancreatitis, recognise the classic appearances and tests, and explain how enzyme replacement, duct drainage, glucocorticoids and insulin act on the mechanism.
What it is
Chronic pancreatitis is long-lasting inflammation of the pancreas that permanently replaces its tissue with fibrosis, narrows and blocks its ducts, often with calcified stones, and in time causes loss of its exocrine (digestive) and endocrine (hormone) function. Unlike acute pancreatitis, the damage does not resolve. Alcohol and smoking are the main causes; genetic, obstructive and autoimmune forms reach the same end.
5 types to tell apart
- Toxic–metabolic (alcohol and smoking)
- About half of cases; often follows repeated acute attacks; calcification and duct stones are common.
- Genetic (hereditary)
- Variants of PRSS1, SPINK1, CTRC or CFTR that let trypsin build up in the gland or thicken its juice; often begins in childhood or youth.
- Obstructive
- A stricture, tumour or stone blocks the main duct (pancreas divisum is a possible cause); damage lies upstream of the block, usually without stones.
- Autoimmune pancreatitis
- Type 1 is part of IgG4-related disease; type 2 is a duct-destructive form. Both often present as a swollen gland with painless jaundice and respond to glucocorticoids.
- Tropical and idiopathic
- Tropical pancreatitis affects children and young adults in regions such as India, Indonesia and Nigeria, with large duct stones; in many people no cause is found.
Normal function
Acini, ducts and islets, with a large reserve
Most of the is exocrine. Acinar cells make the digestive enzymes, kept inactive until they reach the duodenum (see acute pancreatitis). Duct cells add a watery, bicarbonate-rich fluid, secreted through the chloride channel CFTR, which flushes the enzymes down the to the and neutralises stomach acid in the duodenum. Secretin drives the fluid and bicarbonate; cholecystokinin (CCK), released by the duodenum when food arrives, drives the enzymes.
The gland has a large reserve: digestion stays normal until enzyme output falls to about a tenth of normal. Lying quietly around the acini are pancreatic stellate cells, which store vitamin A and can turn into collagen-making cells when the gland is injured.
Scattered through the acinar tissue, the islets of Langerhans make up only a small fraction of the gland. Beta cells make insulin, alpha cells glucagon, delta cells somatostatin and PP cells pancreatic polypeptide.
Underlying change · Step 1 of 6
Repeated injury and a sensitised gland
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Underlying change · Step 2 of 6
Fibrosis, protein plugs and stones
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 3 of 6
Why the pain persists
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Disrupted function · Step 4 of 6
Exocrine failure: fat is not digested
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 5 of 6
Endocrine failure: type 3c diabetes
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Consequences · Step 6 of 6
Strictures, pseudocysts and a blocked splenic vein
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Symptoms and signs
Symptoms, signs and findings
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Exam detail
Exam detail
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Treatment
How treatment works
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Recap
Recap
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .
Self-check
Check your understanding
The full lesson is part of Student Pro
It takes you through all 6 steps of the mechanism, explains the symptoms, signs and findings each step causes, adds the exam detail and how treatment works where the lesson has them, then recaps it and lets you check yourself with 10 self-check questions. The full pathophysiology library: guided lessons with self-check questions comes with Student Pro, with 100 tutor answers a month and the full available catalogue.
Free to read: the introduction and .