WordNet

being long-lasting and recurrent or characterized by long suffering; "chronic indigestion"; "a chronic shortage of funds"; "a chronic invalid"
of long duration; "chronic money problems" (同)continuing
habitual; "a chronic smoker" (同)inveterate
inflammation of the pancreas; usually marked by abdominal pain

PrepTutorEJDIC

(病気が)長期にわたる,慢性の / 《名詞の前にのみ用いて》常習の,癖になった

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2017/01/11 07:04:46」(JST)

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Chronic pancreatitis is a long-standing inflammation of the pancreas that alters the organ's normal structure and functions.^[1] It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. It is a disease process characterized by irreversible damage to the pancreas as distinct from reversible changes in acute pancreatitis.^{[medical citation needed]}

Signs and symptoms

The symptoms consistent with chronic pancreatitis usually present with persistent abdominal pain or steatorrhea resulting from malabsorption of the fats in food. Significant weight loss often occurs due to malabsorption and can continue to be a health problem as the condition progresses. The patient may also complain about pain related to their food intake, especially those meals containing a high percentage of fats and protein.^[1]^[2]

Causes

Among the causes of chronic pancreatitis are the following:^[3]

Alcohol
Autoimmune disorders
Intraductal obstruction
Idiopathic pancreatitis
Tumors
Ischemia
Calcific stones

The relationship between etiologic factors, genetic predisposition, and the pace of disease progression requires further clarification, though recent research indicates smoking may be a high-risk factor to develop chronic pancreatitis.^[4] In a small group of patients chronic pancreatitis has been shown to be hereditary. Almost all patients with cystic fibrosis have established chronic pancreatitis, usually from birth. Cystic fibrosis gene mutations have also been identified in patients with chronic pancreatitis but in whom there were no other manifestations of cystic fibrosis. Obstruction of the pancreatic duct because of either a benign or malignant process may result in chronic pancreatitis.^[5]

Pathophysiology

PRSS1

The mechanism of chronic pancreatitis viewed from a genetic standpoint indicates early onset of severe epigastric pain beginning in childhood. It is an autosomal dominant disease, chronic pancreatitis disease is identified in the cationic trypsinogen gene PRSS1, and mutation, R122H. R122H is the most common mutation for hereditary chronic pancreatitis with replacement of arginine with histidine at amino acid position 122 of the trypsinogen protein. There are, of course, other mechanisms – alcohol, malnutrition, smoking – each exhibiting its own effect on the pancreas.^[6]

Diagnosis

The diagnosis of chronic pancreatitis is based on tests on pancreatic structure and function. Serum amylase and lipase may be moderately elevated in cases of chronic pancreatitis, amylase and lipase are nearly always found elevated in the acute condition. A secretin stimulation test is considered the best test for diagnosis of chronic pancreatitis. Other tests used to determine chronic pancreatitis are serum trypsinogen, computed tomography, ultrasound and biopsy.^[7]^[8]

When chronic pancreatitis is caused by genetic factors, elevations in ESR, IgG4, rheumatoid factor, ANA and anti-smooth muscle antibody may be detected.^[9]

Treatment

The different treatment options for management of chronic pancreatitis are medical measures, therapeutic endoscopy and surgery.^[10] Treatment is directed, when possible, to the underlying cause, and to relieve pain and malabsorption. Insulin dependent diabetes mellitus may occur and need long term insulin therapy.^[11] The abdominal pain can be very severe and require high doses of analgesics, sometimes including opiates. Alcohol cessation and dietary modifications (low-fat diet) are important to manage pain and slow the calcific process.^[10] Antioxidants may help but it is unclear if the benefits are meaningful.^[12]

Pancreatic enzymes

Pancreatic enzyme replacement is often effective in treating the malabsorption and steatorrhea associated with chronic pancreatitis. Treatment of CP consists of administration of a solution of pancreatic enzymes with meals. Some patients do have pain reduction with enzyme replacement and since they are relatively safe, giving enzyme replacement to a chronic pancreatitis patient is an acceptable step in treatment for most patients. Treatment may be more likely to be successful in those without involvement of large ducts and those with idiopathic pancreatitis.^[13]

Surgery

Surgery to treat chronic pancreatitis tends to be divided into two areas – resectional and drainage procedures. Among the reasons to opt for surgery are if there is a pseudocyst, fistula, ascites, or a fixed obstruction.^[3]

Epidemiology

The annual incidence of chronic pancreatitis is 5 to 12 per 100,000 persons, the prevalence is 50 per 100,000 persons.^[14]

References

^ ^a ^b "Chronic pancreatitis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-11-29.
^ Beger, H. G.; Büchler, M.; Ditschuneit, H.; Malfertheiner, P. (2012-12-06). Chronic Pancreatitis: Research and Clinical Management. Springer Science & Business Media. p. 215. ISBN 9783642753190.
^ ^a ^b "Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology".
^ Tolstrup, J. S.; Kristiansen, L.; Becker, U.; Grønbaek, M. (2009). "Smoking and Risk of Acute and Chronic Pancreatitis Among Women and Men". Archives of Internal Medicine. 169 (6): 603–609. doi:10.1001/archinternmed.2008.601. PMID 19307524.
^ Choices, NHS. "Chronic pancreatitis - Causes - NHS Choices". www.nhs.uk. Retrieved 2015-11-29.
^ Brock, Christina; Nielsen, Lecia Møller; Lelic, Dina; Drewes, Asbjørn Mohr (2013-11-14). "Pathophysiology of chronic pancreatitis". World Journal of Gastroenterology : WJG. 19 (42): 7231–7240. doi:10.3748/wjg.v19.i42.7231. ISSN 1007-9327. PMC 3831204. PMID 24259953.
^ "Chronic Pancreatitis. Hereditary pancreas disorders information | Patient". Patient. Retrieved 2015-11-29.
^ "Acute Pancreatitis. Pancreatitis Symptoms and Information | Patient". Patient. Retrieved 2015-11-29.
^ Kapural, Leonardo (2014-12-03). Chronic Abdominal Pain: An Evidence-Based, Comprehensive Guide to Clinical Management. Springer. p. 91. ISBN 9781493919925.
^ ^a ^b American Gastroenterological Association Medical Position Statement (1998). "American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis". Gastroenterology. 115 (3): 763–4. doi:10.1016/S0016-5085(98)70156-8. PMID 9721174. – via ScienceDirect (Subscription may be required or content may be available in libraries.)|Available online 27 October 2005
^ Ewald, Nils; Hardt, Philip D (2013-11-14). "Diagnosis and treatment of diabetes mellitus in chronic pancreatitis". World Journal of Gastroenterology : WJG. 19 (42): 7276–7281. doi:10.3748/wjg.v19.i42.7276. ISSN 1007-9327. PMC 3831209. PMID 24259958.
^ Ahmed Ali, U; Jens, S; Busch, OR; Keus, F; van Goor, H; Gooszen, HG; Boermeester, MA (Aug 21, 2014). "Antioxidants for pain in chronic pancreatitis.". The Cochrane database of systematic reviews. 8: CD008945. doi:10.1002/14651858.CD008945.pub2. PMID 25144441.
^ Sikkens, E. C. M.; Cahen, D. L.; Kuipers, E. J.; Bruno, M. J. (2010-06-01). "Pancreatic enzyme replacement therapy in chronic pancreatitis". Best Practice & Research. Clinical Gastroenterology. 24 (3): 337–347. doi:10.1016/j.bpg.2010.03.006. ISSN 1532-1916. PMID 20510833. – via ScienceDirect (Subscription may be required or content may be available in libraries.)
^ Yadav, Dhiraj; Lowenfels, Albert B. (2013-06-01). "The Epidemiology of Pancreatitis and Pancreatic Cancer". Gastroenterology. 144 (6): 1252–1261. doi:10.1053/j.gastro.2013.01.068. ISSN 0016-5085. PMC 3662544. PMID 23622135.

External links

Medical Information and Treatment of Chronic Pancreatitis

UpToDate Contents

全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.

1. 成人における慢性膵炎の臨床症状および診断 clinical manifestations and diagnosis of chronic pancreatitis in adults
2. 慢性膵炎の治療 treatment of chronic pancreatitis
3. 成人における慢性膵炎の病因および発症機序 etiology and pathogenesis of chronic pancreatitis in adults
4. 慢性膵炎の合併症 complications of chronic pancreatitis
5. 慢性膵炎における超音波内視鏡検査 endoscopic ultrasound in chronic pancreatitis

English Journal

Is cancer a severe delayed hypersensitivity reaction and histamine a blueprint?

Khatami M1.
Clinical and translational medicine.Clin Transl Med.2016 Dec;5(1):35. doi: 10.1186/s40169-016-0108-3. Epub 2016 Aug 23.
Longevity and accumulation of multiple context-dependent signaling pathways of long-standing inflammation (antigen-load or oxidative stress) are the results of decreased/altered regulation of immunity and loss of control switch mechanisms that we defined as Yin and Yang of acute inflammation or immu
PMID 27558401

Pancreatic involvement in cystic fibrosis.

Ozen Alahdab Y1, Duman DG.
Minerva medica.Minerva Med.2016 Dec;107(6):427-436. Epub 2016 Jul 14.
Cystic fibrosis (CF) is an important genetic disorder that usually manifests in early childhood. Better understanding and improved care of CF patients in our current practice with pancreatic enzyme replacement therapy and nutritional support has enabled physicians to see them more frequently from an
PMID 27425634

The potential diagnostic value of serum microRNA signature in patients with pancreatic cancer.

Johansen JS1,2, Calatayud D3, Albieri V4, Schultz NA3, Dehlendorff C4, Werner J5, Jensen BV6, Pfeiffer P7, Bojesen SE8, Giese N5, Nielsen KR9, Nielsen SE10, Yilmaz M11, Holländer NH12, Andersen KK4.
International journal of cancer.Int J Cancer.2016 Nov 15;139(10):2312-24. doi: 10.1002/ijc.30291. Epub 2016 Aug 16.
Biomarkers for early diagnosis of patients with pancreatic cancer (PC) are needed. Our aim was to identify panels of miRNAs in serum in combination with CA 19-9 for use in the diagnosis of PC. Four hundred seventeen patients with PC were included prospectively from Denmark (n = 306) and Germany
PMID 27464352

Japanese Journal

十二指腸粘膜下腫瘍との鑑別が困難であったGroove Pancreatitisの1例

速水克,牛田進一郎,中村徹 [他],清水進一,大月寛郎,亀岡信悟
東京女子医科大学雑誌 85(E1), E43-E48, 2015-03-31
… 部の間に弾性硬の腫瘤を触知し、腫瘤周囲には高度の炎症性変化を認め、亜全胃温存膵頭十二指腸切除術を施行した.病理組織学検索で、膵、Groove領域や十二指腸壁には広範な線維化や慢性炎症細胞浸潤がみられたが、腫瘍性変化は認められなかった.以上の所見からGroove pancreatitisと診断した.Groove pancreatitisはgroove領域に発生する限局性慢性膵炎で、その特徴的所見について文献的考察を加え報告する. …
NAID 110009888980

慢性膵炎・膵石症に対する膵空腸側々吻合術 (特集第67回広島医学会総会) -- (受賞論文の要旨)

首藤毅,宮本勝也,横山雄二郎 [他]
広島医学 68(2), 112-117, 2015-02
NAID 40020386867

Short- and long-term results of the Frey procedure for chronic pancreatitis

Ueda Junji,Miyasaka Yoshihiro,Ohtsuka Takao [他]
Journal of hepato-biliary-pancreatic sciences : official journal of the Japanese Society of Hepato-Biliary-Pancreatic Surgery, the Asian-Pacific Hepato-Pancreato-Biliary Association, the Japan Biliary Association 22(3), 211-216, 2015
NAID 40020403851

Related Pictures

★リンクテーブル★

リンク元	「慢性膵炎」
拡張検索	「chronic pancreatitis showing irregular narrowing of main pancreatic duct」
関連記事	「chronic」

「慢性膵炎」

Chronic pancreatitis
	Axial CT showing multiple calcifications in the pancreas in a patient with chronic pancreatitis
Classification and external resources
Specialty	gastroenterology
ICD-10	K86.0-K86.1
ICD-9-CM	577.1
OMIM	167800
DiseasesDB	9559
MedlinePlus	000221
eMedicine	med/1721
MeSH	D050500
	[edit on Wikidata]

　　[★]

英: chronic pancreatitis
関: 膵炎

疫学

病因

アルコール性が最も多く、胆石、栄養障害、家族性の物があるが、特発性のものが多い。(SSUR.628)

アルコール性(50%以上)＞特発性＞胆石 (QB.B-357)

病態

慢性的な炎症による膵臓の線維化　→　内分泌機能低下、外分泌機能低下、門脈圧迫

症状

代償期には腹痛、非代償期には膵機能の廃絶による諸症状を呈する

非代償期には腹痛は見られる事は少なくなる(burn out現象)

代償期

飲酒、過食、脂肪食で誘発される上腹部痛、背部放散痛

非代償期

消化不良　→　脂肪便下痢、体重減少
膵性糖尿病
胃静脈瘤：脾静脈の閉塞により胃底部に限局する胃静脈瘤が出現。

合併症

検査

外分泌機能：セクレチン試験、BT-PABA排泄試験　←　低下する
内分泌機能：75g OGTT

腹部単純X線写真：膵石
CT：膵管拡張、主膵管の数珠状拡張(QB.B-356)、膵石
MRCP, ERCP：主膵管の拡張・狭窄

診断基準

慢性膵炎臨床診断基準2009

慢性膵炎の診断項目

①特徴的な画像所見
②特徴的な組織所見
③反復する上腹部痛発作
④血中または尿中膵酵素値の異常
⑤膵外分泌障害
⑥1日80g以上（純エタノール換算）の持続する飲酒歴

判定

慢性膵炎確診：a，b のいずれかが認められる．

a．①または②の確診所見．
b．①または②の準確診所見と，③④⑤のうち 2 項目以上．

慢性膵炎準確診：

①または②の準確診所見が認められる．

早期慢性膵炎：

③～⑥のいずれか 2 項目以上と早期慢性膵炎の画像所見が認められる．

診断項目の詳細

①特徴的な画像所見

確診所見：以下のいずれかが認められる．

a．膵管内の結石．
b．膵全体に分布する複数ないしび漫性の石灰化．
c．ERCP 像で，膵全体に見られる主膵管の不整な拡張と不均等に分布する不均一かつ不規則な分枝膵管の拡張．
d．ERCP 像で，主膵管が膵石，蛋白栓などで閉塞または狭窄している時は，乳頭側の主膵管と分枝膵管の不規則な拡張．

準確診所見：以下のいずれかが認められる．

a．MRCP において，主膵管の不整な拡張と共に膵全体に不均一に分布する分枝膵管の不規則な拡張．
b．ERCP 像において，膵全体に分布するび漫性の分枝膵管の不規則な拡張，主膵管のみの不整な拡張，蛋白栓のいずれか．
c．CT において，主膵管の不規則なび漫性の拡張と共に膵辺縁が不規則な凹凸を示す膵の明らかな変形．
d．US（EUS）において，膵内の結石または蛋白栓と思われる高エコーまたは膵管の不整な拡張を伴う辺縁が不規則な凹凸を示す膵の明らかな変形．

②特徴的な組織所見

確診所見：膵実質の脱落と線維化が観察される．膵線維化は主に小葉間に観察され，小葉が結節状，いわゆる硬変様をなす．
準確診所見：膵実質が脱落し，線維化が小葉間または小葉間・小葉内に観察される．

④血中または尿中膵酵素値の異常

以下のいずれかが認められる．

a．血中膵酵素が連続して複数回にわたり正常範囲を超えて上昇あるいは正常下限未満に低下．
b．尿中膵酵素が連続して複数回にわたり正常範囲を超えて上昇．

⑤膵外分泌障害

BT-PABA試験で明らかな低下を複数回認める．

参考

hpblondon.com

http://www.hpblondon.com/chronic-pancreatitis/

hpblondon.com - MRCP

http://www.hpblondon.com/chronic-pancreatitis/index_files/mrcp_chronic_pancreatitis.jpg

「chronic pancreatitis showing irregular narrowing of main pancreatic duct」

　　[★] 自己免疫性膵炎、膵管狭細型慢性膵炎

「chronic」

　　[★]

adj.

慢性の、慢性的な、慢性型の

関: chronically、chronicity

[nih-1] "Chronic pancreatitis: MedlinePlus Medical Encyclopedia". www.nlm.nih.gov. Retrieved 2015-11-29.

[2] Beger, H. G.; Büchler, M.; Ditschuneit, H.; Malfertheiner, P. (2012-12-06). Chronic Pancreatitis: Research and Clinical Management. Springer Science & Business Media. p. 215. ISBN 9783642753190.

[emed-3] "Chronic Pancreatitis: Practice Essentials, Background, Pathophysiology".

[4] Tolstrup, J. S.; Kristiansen, L.; Becker, U.; Grønbaek, M. (2009). "Smoking and Risk of Acute and Chronic Pancreatitis Among Women and Men". Archives of Internal Medicine. 169 (6): 603–609. doi:10.1001/archinternmed.2008.601. PMID 19307524.

[5] Choices, NHS. "Chronic pancreatitis - Causes - NHS Choices". www.nhs.uk. Retrieved 2015-11-29.

[6] Brock, Christina; Nielsen, Lecia Møller; Lelic, Dina; Drewes, Asbjørn Mohr (2013-11-14). "Pathophysiology of chronic pancreatitis". World Journal of Gastroenterology : WJG. 19 (42): 7231–7240. doi:10.3748/wjg.v19.i42.7231. ISSN 1007-9327. PMC 3831204. PMID 24259953.

[7] "Chronic Pancreatitis. Hereditary pancreas disorders information | Patient". Patient. Retrieved 2015-11-29.

[8] "Acute Pancreatitis. Pancreatitis Symptoms and Information | Patient". Patient. Retrieved 2015-11-29.

[9] Kapural, Leonardo (2014-12-03). Chronic Abdominal Pain: An Evidence-Based, Comprehensive Guide to Clinical Management. Springer. p. 91. ISBN 9781493919925.

[pmid9721174-10] American Gastroenterological Association Medical Position Statement (1998). "American Gastroenterological Association Medical Position Statement: treatment of pain in chronic pancreatitis". Gastroenterology. 115 (3): 763–4. doi:10.1016/S0016-5085(98)70156-8. PMID 9721174. – via ScienceDirect (Subscription may be required or content may be available in libraries.)|Available online 27 October 2005

[11] Ewald, Nils; Hardt, Philip D (2013-11-14). "Diagnosis and treatment of diabetes mellitus in chronic pancreatitis". World Journal of Gastroenterology : WJG. 19 (42): 7276–7281. doi:10.3748/wjg.v19.i42.7276. ISSN 1007-9327. PMC 3831209. PMID 24259958.

[12] Ahmed Ali, U; Jens, S; Busch, OR; Keus, F; van Goor, H; Gooszen, HG; Boermeester, MA (Aug 21, 2014). "Antioxidants for pain in chronic pancreatitis.". The Cochrane database of systematic reviews. 8: CD008945. doi:10.1002/14651858.CD008945.pub2. PMID 25144441.

[13] Sikkens, E. C. M.; Cahen, D. L.; Kuipers, E. J.; Bruno, M. J. (2010-06-01). "Pancreatic enzyme replacement therapy in chronic pancreatitis". Best Practice & Research. Clinical Gastroenterology. 24 (3): 337–347. doi:10.1016/j.bpg.2010.03.006. ISSN 1532-1916. PMID 20510833. – via ScienceDirect (Subscription may be required or content may be available in libraries.)

[14] Yadav, Dhiraj; Lowenfels, Albert B. (2013-06-01). "The Epidemiology of Pancreatitis and Pancreatic Cancer". Gastroenterology. 144 (6): 1252–1261. doi:10.1053/j.gastro.2013.01.068. ISSN 0016-5085. PMC 3662544. PMID 23622135.

匿名

検索

案内

chronic pancreatitis