Chronic Pancreatitis

Year 2017, Volume: 9 Issue: 3, 17 - 23, 15.05.2017

Yrd. Doç. Dr. Selçuk Yazıcı

Abstract

Abstract

Chronic pancreatitis (CP) is rare in childhood, butits incidence is increasing with age. CP and acute re-current pancreatitis (ARP) are regarded as different sta-ges of the same disease rather than two separate diseases. The main causes are genetic factors (most common),obstructive, toxicmetabolic, autoimmune and idiopathic conditions. The disease is characterized by severe episodes of recurrent pain. Deterioration of endocrineand exocrine functions of the pancreas may be seen.In most cases, amylase and lipase are normal or slightly elevated. Elevated levels of transaminases, direct bilirubin, alkaline phosphatase and gamma glutamyltransferase are detected in concomitant bile duct obstructions. It is suggested that the initial evaluation ofrecurrent pancreatitis should include aspirate aminotransferase, alanine aminotransferase, gammaglutamyltransferase, total bilirubin, fasting lipids and total serum calcium, if metabolic disease is suspected serumammonia and urine organic acids.Magnetic resonance cholangiopancreatography(MRCP), secretin-induced magnetic resonance cholan-giopancreatography (SMRCP), endoscopic retrogradecholangiopancreatography (ERCP) and endoscopic ultrasonography (EUS) are the preferred imaging modalities. Sweat test and cationic trypsinogen (PRSS1) genemutation test should be performed during ARP or CPgenetic screening. If sweat testing is not possible, cysticfibrosis transmembrane regulator (CFTR) mutation should be examined.Functions in exocrine pancreatic insufficiency canbe assessed by indirect methods such as fecal fat analysis, fecal elastase-1, fecal chymotrypsin, serum immu-noreactive trypsinogen, levels of fat soluble vitamins or direct tests such as pancreas stimulation test withDreiling tube or endoscopic pancreas function test.All acute and acute recurrent pancreatitis cases, especially idiopathic cases, should be monitored regularly.Screening for Celiac disease is recommended in long-term follow-up of ARP or CP patients. Pediatric ARPand CP patients should be assessed at least once a yearfor fat-soluble vitamin deficiencies, pancreatic exocrine and endocrine deficiencies.

Keywords

Chronic pancreatitis, childho-od, diagnosis, follow-up

Kronik Pankreatitler

Abstract

Öz

Kronik pankreatit (KP)çocukluk çağında nadir görülen ancak insidansı yaşla artan bir hastalıktır. Akut tekrarlayıcı pankreatit (ARP) ile KP iki ayrı hastalık yerine bir hastalığın farklı aşamaları olarak kabul edilmektedir. Başlıca nedenler genetik faktörler (en sık), obstrüktif, toksik-metabolik, otoimmün ve idiyopatik durumlardır. Hastalık şiddetli tekrarlayıcı ağrı epizotları ile karakterizedir. Pankreasın endokrin ve ekzokrin fonksiyonlarında bozulma görülebilmektedir.Olguların çoğunda amilaz ve lipaz normal veya hafif yüksektir. Eşlik eden safra yolları obstrüksiyonlarında, transaminazlar, direkt bilirubin, alkalen fosfatazve gamma glutamil transferaz düzeylerinde yükselme saptanır. Tekrarlayan pankreatitin ilk değerlendirmesinin aspartat aminotransferaz, alanin aminotransferaz, gamaglutamiltransferaz, total bilirubin, açlık lipidleri ve total serum kalsiyumu, metabolik hastalık şüphesi varsa serum amonyak ve idrar organik asitleri tetkiklerini içermesi önerilmektedir. Manyetik rezonans kolanjiyopankreatografi (MRCP), sekretinli manyetik rezonans kolanjiyopankreatografi (SMRCP),endoskopik retrograd kolanjiopankreatografi (ERCP) ve endoskopik ultrasonografi (EUS) tercih edilen görüntüleme yöntemleridir. ARP veya KP'nin genetikaçıdan taraması sırasında ter testi ve katyonik tripsinojen (PRSS1) gen mutasyontesti yapılmalı, ter testi yapılamıyorsa, kistik fibroz transmembran regülatör (CFTR)mutasyonu bakılmalıdır.Ekzokrin pankreas yetmezliğinde fonksiyonlar fekal yağ analizi, fekal elastaz-1, dışkıda kimotripsin, serum immün reaktif tripsinojen, yağda eriyen vitamin düzeyleri gibi indirekt testler veya Dreiling tüpü ile pankreas stimülasyon testi veya endoskopik pankreas fonksiyon testi gibi direkt yöntemlerle değerlendirilebilir. Tüm akut ve akut tekrarlayan pankreatit vakalarının, özellikle idiyopatik olguların, düzenli olarak izlenmesi gereklidir. Uzun vadeli izlemde ARP veya KP hastalarının Çölyak hastalığı için araştırılması önerilmektedir. Pediatrik ARP ve KP hastaları yağda çözünen vitamin eksiklikleri, pankreatik ekzokrin ve endokrin yetmezlikler açısından yılda en az bir kez değerlendirilmelidir.

Keywords

Kronik pankreatit, çocuklukçağı, tanı, izlem

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