Pat: acute vs chronic pancreatitis

[Guest guest]

Hi Pat,

In a very broad general sense....acute pancreatitis is the active

stage of the disease at which time the pancreas is being acutely

destroyed. By definition using a " purist " point of view (remember,

there are many points of view on this topic) acute pancreatitis by

definition occurs suddenly, peaks abruptly, has to show elevated

amylase, lipase, inflammed pancreas, fluid around the organ,

extreme pain, nausea, vomitting etc - a generally very sick

person. This usually sustains itself for a few days to a few

weeks. After the immediate insult, the pain, inflammation,

enzyme levels, etc usually go down and the person eventually

heals. Most of the causes of AP is some type of ductal

obstruction - from gallstones, inflammation in the ducts,

calcification, mucin plugs, alcohol, etc...... and usually are a one

time thing and heals unless the inciting factor is still active (like

drinking with alcohol CP, or taking the medicines that cause it, or

if the gallstones are not removed for example).

Chronic pancreatitis is open to debate. There is much

controversy surrounding its definition, detection, treatment and

cause. It is not clear if AP can lead to CP or if other factors are

needed in order to become chronic. There is also debate on

whether you can be CP without ever having AP. Again, the purist

will define CP as showing distinct, fairly well characterized signs

and symptoms including: strictures, calcifications, masses,

pseudocysts, dilatations, obstruction, pain, malabsorption,

nausea, vomitting, diarrhea, etc. However, for the most part, the

person does not sustain the very sick stage like you see with AP

- the patient can usually cope to some extent.

Unfortunately, signs of CP usually occur years or even decades

after the symptoms start. The purist GI will not diagnose CP until

the signs become apparent. However the more liberal GI doc will

acknowledge that there is such a creature as early stage CP and

that it can be diagnosed by symptoms alone (or with symptoms

along with a few signs) taking into consideration the person's

medical history, co-morbidities and using " gut instinct " . Only

time will tell in these cases whether the more liberal or the

purists are right. The whole continuum of AP to CP (if it even

exists) is subject to much research and heated debate. It is my

experience that for every GI doc that you consult with about this,

you will receive a different answer.

Sorry to confuse you, but unfortunately this is a disease about

which there is not much known.

I am sure that there are others who can explain this much better

than I just attempted to do

Laurie

Oh - signs to doctors, from what I understand, are so-called

" objective " measures of a disease whereas symptoms are

those that are open to subjective interpretation, given by the

patient and analyzed by the physician for credibility. So lab

results, radiology, vital signs, bruising, bleeding, etc are

signs....pain, tiredness, nausea, chills, etc are symptoms.