What is chronic pancreatitis?
Chronic Pancreatitis (CP) refers to the persistent inflammation of pancreatic tissue caused by various etiologies, resulting in progressive destruction of pancreatic parenchyma, ducts and other structures, which may eventually lead to endocrine and exocrine insufficiency of the pancreas, and is characterized by pancreatic fibrosis. Yamin Lai, Department of Gastroenterology, Peking Union Medical College Hospital
How to diagnose chronic pancreatitis?
The diagnostic criteria of chronic pancreatitis in China’s guidelines for the diagnosis and treatment of chronic pancreatitis (Nanjing, 2005) are, based on the exclusion of pancreatic cancer, the following four items are recommended as the main diagnostic basis for chronic pancreatitis.
(1) Typical clinical manifestations (abdominal pain, symptoms of pancreatic exocrine insufficiency).
(2) Pathological examination.
(3) imaging signs of pancreaticobiliary changes of chronic pancreatitis.
(4) laboratory tests based on pancreatic exocrine insufficiency. Item 1 is necessary for diagnosis, positive item 2 can confirm the diagnosis, 1+3 can basically confirm the diagnosis, and 1+4 is a suspected patient.
According to the Asia-Pacific consensus opinion, the diagnostic criteria for chronic pancreatitis are.
① Histopathological examination of the pancreas consistent with chronic pancreatitis.
② X-ray, ultrasound or CT findings of pancreatic calcification or stones.
③Signs and symptoms of typical chronic pancreatitis, abnormal exocrine function tests, chronic pancreatitis features such as ER chronic pancreatitis or MR chronic pancreatitis showing pancreatic ductal changes, and excluding pancreatic cancer.
④Characteristic changes of chronic pancreatitis under EUS. Definitive diagnosis must meet at least 1 of the above criteria. That means the diagnosis of chronic pancreatitis is not that simple.
What kind of people are prone to chronic pancreatitis? What are the common causes of chronic pancreatitis?
There are many factors closely related to chronic pancreatitis, such as: alcohol intake, biliary tract disease, genetics, nutrition, trauma and autoimmunity.
In different countries and regions, the causative factors and incidence rates vary greatly due to many factors such as geographic environment, economic status and living habits. For example, alcohol intake is the first cause of chronic pancreatitis in Western countries (50% to 70%); tropical pancreatitis occurs in tropical or subtropical countries in Asia, Africa and South America; while in China, biliary tract disease is the most common cause (46.5%), but the incidence of alcoholic pancreatitis has been on the rise in recent years.
Why do people who drink a lot of alcohol for a long time get chronic pancreatitis?
It is currently believed that alcohol intake and drinking time are closely related to the incidence of chronic pancreatitis, with a general daily intake of more than 150g susceptible to disease, but a daily intake of 75-100g also has a damaging effect on the pancreas, and most of these patients have a long history of alcohol consumption, at least 4-5 years.
The exact mechanism of chronic pancreatitis triggered by alcohol may be: alcohol stimulates pancreatic secretion, increases the sensitivity of the pancreas to stimulation by cholecystokinin CCK, increases the content of pancreatic enzymes and proteins in the pancreatic fluid, increases the concentration of calcium ions, and forms some small protein plugs to block the small pancreatic ducts, leading to changes in the structure of the pancreas.
What is pancreatic schwannomatosis?
Pancreas divisum is a very rare congenital malformation in which the dorsal and ventral pancreatic parenchyma fail to fuse to form a double pancreas during development. The definition of pancreas divisum is now broadened to a congenital developmental anomaly of the pancreatic ducts, which is the most common congenital variant in the development of the pancreatic ducts, usually referring to the non-fusion of the ventral and dorsal pancreatic ducts during development. The incidence of pancreatic splitting in the human population is approximately 10.
What is the difference between chronic pancreatitis and acute pancreatitis?
Chronic pancreatitis (chronic pancreatitis) is a persistent, permanent damage to the tissues and functions of the pancreas caused by various factors. The pancreatic gland shows different degrees of alveolar atrophy, pancreatic duct deformation, fibrosis and calcification, and different degrees of pancreatic exocrine and endocrine dysfunction, resulting in the corresponding clinical symptoms.
Acute pancreatitis is an acute chemical inflammation of the pancreas and is a medical emergency. Its pathogenesis is the abnormal occurrence of digestion of the glandular tissue itself by pancreatic enzymes produced by the pancreas, which leads to tissue damage.
Chronic pancreatitis is not recurrent acute pancreatitis, which is called recurrent acute pancreatitis.
What are the main functions of the pancreas
The pancreas has two main functions: endocrine and exocrine
The endocrine part secretes various hormones: mainly insulin and glucagon, followed by growth hormone-releasing inhibitory hormone, intestinal vasoactive peptide, gastrin, etc., which are involved in regulating body metabolism and maintaining the stability of the internal environment.
The main component of exocrine is pancreatic juice, which contains alkaline bicarbonate and various digestive enzymes, whose function is to neutralize gastric acid and digest sugar, protein and fat.
What are the manifestations of chronic pancreatitis?
The clinical manifestations of chronic pancreatitis vary in severity. Mild chronic pancreatitis has no obvious specific clinical manifestations. Moderate and severe chronic pancreatitis can have a variety of clinical manifestations, mainly chronic pancreatitis itself or acute attack symptoms, pancreatic insufficiency and complications of performance.
Abdominal pain is the main clinical symptom of chronic pancreatitis, and more than 95% of chronic pancreatitis will have abdominal pain, which is characterized by: intermittent at first, then becomes persistent, mostly located in the middle of the epigastrium or left or right epigastrium, and can be radiated to the back, both hypochondrium, anterior chest and other places. The pain varies in severity, and is mostly dull or drilling pain. Abdominal pain is often triggered by alcohol, satiety, high-fat meals or exertion. In some patients, the pain is related to the change of position, which is aggravated when lying down in a flat position or after eating, and can be relieved when sitting in a forward leaning position or bending over, or lying on the side with legs curled, which is the characteristic of pancreatic pain position. The mechanism of abdominal pain is still unclear, and may be related to the stimulation of nerve tissue in the pancreas by inflammatory mediators, fibrosis and adhesions pulling on the ganglion, pancreatic duct obstruction, and increased pressure in the pancreatic duct. With the aggravation of pancreatic fibrosis, abdominal pain gradually reduces or even disappears in some patients.
2, pancreatic exocrine insufficiency, that is, the symptoms of indigestion: loss of appetite, postprandial epigastric fullness and bloating, intolerance of greasy food, nausea, belching and other indigestive symptoms, is due to the reduction of pancreatic digestive enzyme secretion. In severe cases (about 27% to 42%), diarrhea/steatorrhea occurs. In addition to the increased number of bowel movements, ranging from 3 to 10 times a day, the typical steatorrhea is characterized by light-colored stools, often with foam and bad odor, and even oily or oily droplets on the surface, and microscopic examination reveals fat droplets and indigestible muscle fibers. …… About long-term fat and protein malabsorption, the patient suffers from wasting, malnutrition, swelling and vitamin A, D, E, and K deficiency, causing night blindness. K deficiency caused by night blindness, skin roughness, calcium malabsorption and other manifestations.
3, abnormal glucose metabolism chronic pancreatitis islet cell involvement, insufficient insulin secretion, that is, endocrine insufficiency of the pancreas. It is manifested as abnormal glucose tolerance test and can be complicated by overt diabetes at a later stage. Chronic pancreatitis caused by long-term alcohol consumption is more likely to be complicated by diabetes.
Why do patients with chronic pancreatitis often develop diabetes mellitus?
In chronic pancreatitis, the disease persists and occurs repeatedly, causing more serious damage and necrosis to the islet tissue than in acute pancreatitis, in which the damage to B cells may be more serious than that to A cells, resulting in a change in the A/B cell ratio from the normal 1:2 to 2:1 and the development of secondary diabetes. The severity of diabetes mellitus is highly correlated with the degree of reduction in B-cell number. Early stage patients may not have a significant reduction in fasting insulin, but only show impaired insulin secretion after glucose loading, probably because the islet cells have a certain compensatory capacity. It has been reported that as long as 20% to 40% of B cells are present, the fasting blood glucose level of patients can be maintained at normal. However, as long as 20% to 40% of total B cells are damaged, it can cause abnormal insulin release response. In the later stage, due to repeated inflammatory stimulation, the damage to B cells gradually worsens, resulting in a significant decrease in the number of B cells and a significant decrease in their function, resulting in a significant decrease in insulin secretion and the eventual development of secondary diabetes.
What laboratory tests are required for chronic pancreatitis?
I. General laboratory tests
Blood leukocytes, blood biochemical examination, serum amylase, blood glucose measurement and glucose tolerance test, stool examination, CA19-9, etc.
Determination of pancreatic exocrine function
Direct test: The pancreatic secretion is directly stimulated by certain gastrointestinal hormones, and the pancreatic fluid is collected directly through the intubation to the duodenum to analyze the amount and composition of pancreatic fluid secretion to estimate the exocrine function of the pancreas. The direct test has higher sensitivity and specificity, but it is not easily accepted by patients because of the intubation, expensive reagents and time-consuming test.
Indirect tests: including fecal elastase test, Lundh test, pancreatic function peptide test (BT-PABA test), etc., are simple and easy to perform.
Pancreatic endocrine function measurement
Fasting blood sugar, glucose tolerance test, plasma insulin, etc. can be measured.
What imaging tests are needed for chronic pancreatitis?
X-ray abdominal radiograph: In some cases, calcified spots, stones or limited dilated intestinal loops along the pancreas can be seen in the abdominal plain radiograph.
Abdominal ultrasound: Based on the morphology and echo of the pancreas and changes in the pancreatic ducts can be used as a primary screening test for chronic pancreatitis, but the sensitivity of the diagnosis is not high.
Ultrasound endoscopy (EUS): The diagnosis of chronic pancreatitis is better than abdominal ultrasound, with a diagnostic sensitivity of 80%. The sonographic manifestations mainly include pancreatic parenchymal echogenicity enhancement, main pancreatic duct stenosis or irregular dilatation and branch pancreatic duct dilatation, pancreatic duct stones, pseudocysts, etc.
CT/MRI examination: CT shows pancreatic enlargement or shrinkage, irregular contour, pancreatic calcification, irregular dilatation of pancreatic duct or peripancreatic pancreatic __ pseudocysts, etc. The diagnostic value of MRI for chronic pancreatitis is similar to CT, but it is inferior to CT for calcification and stones.
Imaging of the pancreatic and biliary ducts: the main methods are endoscopic retrograde cholangiopancreatography (ERCP) and magnetic resonance cholangiopancreatography (MRCP).
Histopathological and cytological examination of chronic pancreatitis
Surgical biopsy is the most ideal specimen, but it is usually difficult to obtain; ultrasound (abdomen, EUS) or CT-guided puncture biopsy, or ERCP to collect pancreatic duct secretion for cytological examination is the most common method, which is an important basis for differentiating chronic pancreatitis from pancreatic cancer.
What is MRCP and what does it mean for the diagnosis of pancreatic diseases?
Magnetic resonance cholangiopancreatography (MRCP) is a non-invasive pancreatic bile duct imaging technique developed in recent years, which does not require contrast agent and is not affected by operating techniques.
MRCP is the best alternative method to observe the morphology of the pancreaticobiliary ducts. In cases of obstructive jaundice, it helps to determine the site, extent and pathological nature of the obstruction, and its sensitivity is 91% to 100%]. Although the image is inferior to ERCP and PTC, ERCP has the possibility of complications (5%) and 10%-15% are unsuccessful. MR in chronic pancreatitis can show the biliary tract without contrast, and is simple, safe, non-invasive, easily accepted by the patient and without complications. Especially for bile duct obstruction above the level of the hepatoportal, MRCP can show each segment of the obstructed and dilated bile duct and the distal and proximal segments of the obstructed duct at one time, while PTC and ERCP are difficult to have this ability. However, the spatial resolution of MRCP is not as good as that of ERCP, and the reconstructed image tends to obscure small lesions; it cannot distinguish gas, blood clots and stones in the bile duct according to the signal; and it has poor diagnostic specificity for inflammatory lesions.
What is meant by the five signs of chronic pancreatitis
The typical five signs of chronic pancreatitis, namely persistent epigastric pain, pancreatic calcification, pancreatic pseudocyst, steatorrhea and diabetes mellitus, can be used as a basis for diagnosis, but only a few patients have the five signs.
What are the principles of treatment for chronic pancreatitis?
The principles of treatment for chronic pancreatitis are to control symptoms, improve pancreatic function and treat complications. If the cause is clear, the etiology should be treated.
What are the treatments for intractable abdominal pain?
Treatment of pain.
(1) General treatment: pain can be reduced or temporarily relieved by abstaining from alcohol and controlling diet.
(2) Analgesic drugs: the use of anticholinergic drugs may achieve pain relief in mild cases, and narcotic analgesics may be used in severe pain, but they should be used with caution.
(3) Inhibition of pancreatic enzyme secretion: pancreatic enzyme replacement therapy can relieve or alleviate abdominal pain. Growth inhibitors and their analogues, H2 receptor antagonists or proton pump inhibitors are effective in reducing abdominal pain.
(4) Antioxidants: In patients with alcoholic chronic pancreatitis, pain may be relieved with the application of antioxidants (e.g. vitamins A, C, E, selenium, methionine).
(5) For patients with intractable severe pain and ineffective drug therapy, abdominal plexus block can be done under CT and EUS induction. Those with pancreatic duct stenosis and pancreatic duct stones can be treated accordingly under endoscopy.
(6) If the above methods are ineffective, surgical treatment should be considered.
Why patients with chronic pancreatitis should stop drinking alcohol
Long-term heavy alcohol consumption is an important cause of pancreatitis. Patients diagnosed with chronic pancreatitis should stop drinking to avoid continuous damage to the pancreas from alcohol.
Do patients with chronic pancreatitis need to quit smoking?
Smoking is a risk factor for pancreatic cancer and is associated with chronic pancreatitis and type II diabetes. P Maisonneuve, a foreign scholar, studied 934 patients with a history of chronic alcoholic pancreatitis who smoked and compared their age of diagnosis of pancreatitis with that of nonsmokers. The results showed that: the age of diagnosis of pancreatitis in smokers was on average 4.7 years earlier than in nonsmokers (p=0.001), and smoking significantly increased the risk of pancreatic calcification and increased the risk of diabetes (HR 2.3 ( 95% CI 1.2C4.2)). Therefore, smoking advances the age of diagnosis of chronic alcoholic pancreatitis and is associated with the development of pancreatic calcification and diabetes mellitus. Patients who smoke should quit smoking as soon as possible.
What to pay attention to in the diet of patients with chronic pancreatitis
Patients with chronic pancreatitis must absolutely abstain from alcohol and avoid overeating. Strictly limit fat intake during the attack. If the systemic nutritional status is affected by malabsorption, give parenteral or enteral nutrition treatment, pay attention to the supplementation of fat-soluble vitamins, vitamin B and folic acid, and appropriate supplementation of various trace elements.
Under what circumstances do patients with chronic pancreatitis need surgical treatment?
Surgical treatment is divided into emergency surgery and elective surgery.
(1) Indications for emergency surgery: complications of pseudocysts, such as infection, rupture and bleeding.
(2) Indications for elective surgery.
(①) Persistent pain that has not been treated with internal medicine.
(2) Those with complications of pancreatic pseudocyst, pancreatic fistula or pancreatic duct stones for which endoscopic treatment is ineffective or cannot be performed.
③ with surgically treatable biliary tract diseases such as stones and bile duct strictures.
④ obstructive jaundice that is difficult to subside due to chronic pancreatitis.
⑤ Those who cannot exclude pancreatic cancer.
Do patients with chronic pancreatitis after surgery need to control their diet? Do patients with chronic pancreatitis after surgery still need to take medication?
The surgical treatment of chronic pancreatitis is palliative surgical treatment rather than radical surgical treatment, which aims at long-term relief of abdominal pain, control of complications and maximum preservation of the internal and external secretory function of the pancreas.
Therefore, even if the surgery is successful, dietary control and smoking cessation are still necessary.
Depending on the degree of symptoms and impaired endocrine function, a significant number of patients still require pharmacological treatment. Some patients with well preserved pancreatic function and no clinical symptoms can even reduce or eliminate the need for medication.
What is the most effective way to take pancreatic enzyme preparation for the treatment of chronic pancreatitis diarrhea?
Chronic pancreatitis diarrhea is often manifested as steatorrhea, which is a digestive malabsorption caused by insufficient exocrine function, manifested as an increase in the number and volume of stools, light-colored, loose, greasy and foul-smelling stools, which often float on the water surface and are not easy to flush out.
Treatment is based on pancreatic enzyme replacement therapy. The goal is to make the total amount of pancreatic enzymes released into the duodenum after meals reach more than 5%-10% of the normal amount of pancreatic enzymes excreted, so it can be deduced that the amount of lipase required for each meal is about 25-50 KU, and in order to simulate the normal state of pancreatic enzyme secretion and achieve the best digestive replacement effect, we need to pay attention to the way pancreatic enzyme preparations are taken.
For example, the best way to take the pancreatic enzyme is to take 1 capsule after the first few bites of a meal, 2 capsules during the meal, and 1 capsule at the end of the meal. Three times a day or with the number of meals, not chewable. It is not advisable to take the medication before a meal, partly because the pancreatic enzyme cannot be mixed with food adequately, and partly because stomach acid is not neutralized by food buffer, which can lead to inactivation of excessive pancreatic enzyme.
When pancreatic enzyme replacement therapy alone is not effective, dietary adjustments should be considered to assist in treatment. The diet requires moderate fat (30%), high protein (24%), low carbohydrate (40%), and fat intake can be controlled at 50-75 g per day. dietary fat can aggravate steatorrhea, so dietary fiber intake should be limited.
When the above treatment is not effective in relieving steatorrhea, acid suppression therapy should be used in combination to maintain a postprandial gastric pH greater than 4 for more than 60 minutes and a duodenal pH greater than 4 for more than 90 minutes. Generally, acid suppressants are given before meals.
How to prevent chronic pancreatitis
The prevention of chronic pancreatitis is based on prevention and control of the cause, low-fat diet, smoking and alcohol cessation, and active treatment of the original disease.
The common causes of chronic pancreatitis in Chinese people are alcohol and gallstone disease. Therefore, it is very important to maintain a healthy lifestyle, quit smoking and drinking, and have a low-fat diet. You should have regular checkups and if gallstone disease is found you should consult your doctor in time. Repeated episodes of acute pancreatitis or persistent abdominal pain and jaundice should be investigated further at a tertiary care hospital.
How is pancreatic pseudocyst formed?
Pancreatic pseudocysts are cysts formed when the pancreatic duct ruptures and pancreatic fluid spills out and collects in the peripancreatic tissue or omental sac.
In what cases pancreatic pseudocysts need non-conservative treatment (size, infection compression)
The choice of treatment should be determined by the size of the cyst, the presence or absence of symptoms and complications, and the duration of the disease.
In acute pseudocysts, observation should be done for more than 6 weeks first. The best option is to perform ultrasound follow-up periodically (less than or equal to every 3 months) during the observation period to observe whether the cysts dissipate or increase in size. Chronic pseudocysts of larger size are mostly not self-absorbing and should be operated as soon as possible if there are symptoms (persistent abdominal and back pain, etc.) to reduce the occurrence of serious complications such as cyst rupture. Regardless of acute or chronic cysts, the following manifestations often suggest a small possibility of cyst self-absorption.
1, cysts larger than 6 cm and more than 12 weeks.
2, with chronic pancreatitis.
3, other pancreatic duct abnormalities, such as strictures, in addition to the pancreatic ducts and cysts communicating with each other.
4, imaging suggests a thick cyst wall.
Indications for surgical treatment include.
1, complications such as bleeding, infection, rupture, and compression.
2, cysts larger than 6 cm in diameter.
3, cysts that do not shrink but become larger with conservative treatment.
4, multiple cysts.
5, thick cyst wall.
6, combined with chronic pancreatitis and pancreatic duct stenosis.
What are the methods to treat pancreatic pseudocysts?
Surgical treatment methods Currently, the treatment of pancreatic pseudocysts is mainly surgical. The purpose is to drain the cystic fluid; remove symptoms; prevent and treat serious complications such as cyst rupture, bleeding, infection and obstruction.
The timing of surgery is mostly considered to be postponed to allow enough time for the cyst wall to form a mature fibrotic envelope. Premature surgery is often due to the brittle cyst wall, which cannot be effectively sutured and is prone to postoperative anastomotic fracture.
2.Surgical modalities There are three types of commonly used surgical modalities.
(1) Cyst removal: the most ideal method, but mostly only for smaller cysts in the tail of the pancreas, the operation is more difficult for large cysts.
(2) Cyst drainage: In the past, external drainage was considered to be the first choice for the treatment of pancreatic pseudocysts, but due to the high incidence of pancreatic fistula after external drainage, most scholars are now gradually moving towards internal drainage surgery. Shatney and Lillehei reviewed the results of 119 cases of surgical treatment of pancreatic pseudocysts and concluded that the mortality rate and complication rate of internal drainage were low. The cyst-gastric anastomosis is preferred for internal drainage. This procedure allows the cyst to dissipate. For those who are not suitable for cyst-gastric anastomosis, the cyst can be drained into the jejunum or duodenum according to the Roux-en-y method.
(3) Pancreatic resection: Pancreatic resection is often performed when the pancreas has serious lesions or malignant tumors, and can be performed as pancreaticoduodenectomy, pancreatic body caudal resection or total pancreatectomy.
3, laparoscopy: including cystic gastric anastomosis and cystic intestinal anastomosis, etc. The number of reported cases is relatively small, but has shown good prospects.
Non-surgical treatment of pancreatic pseudocysts
Percutaneous puncture and drainage (PCD): This method is guided by ultrasound or CT to drain the cyst through the abdominal cavity, retroperitoneum, stomach, liver or duodenum, among which transgastric drainage is most commonly used to drain the cystic fluid outside the body or to drain the cystic fluid into the gastric lumen through a catheter. Internal separation of the cyst and poor drainage of the cystic fluid are the main causes of PCD failure and are often used only as a temporary treatment in emergency cases such as large cysts with the potential for compression, rupture, or co-infection.
Transendoscopic drainage: This includes both transduodenal papillary drainage of the cyst and transgastric drainage of the cyst through the wall of the gastrointestinal tract. The choice of drainage method depends on the anatomical relationship between the pseudocyst and the stomach or duodenum, whether the pancreatic duct is connected to the cyst and the size of the cyst. The indications for endoscopic drainage are.
1, cysts more than 6 weeks old, with indications for treatment and tumor ruled out.
2, CT or ultrasound endoscopy confirms tight adhesion of the cyst to the stomach or duodenum or endoscopic compression of the stomach or duodenum with internal protrusion.
3, cyst wall less than 1 cm.
4. Normal coagulation. The effectiveness of endoscopic treatment of pancreatic pseudocysts depends on the type of fluid drainage and the experience of the endoscopic specialist. Serious complications include bleeding, perforation, infection, pancreatitis, stent ectopic or blockage, pancreatic duct injury, etc. Therefore, it needs to be able to be backed up by interventional vascular embolization or surgery. In recent years, ultrasonic endoscopic puncture has greatly improved the success rate of endoscopic internal drainage of cystic fluid and reduced complications. As an internal drainage procedure without surgery, its future is undoubtedly promising.
How to medically follow up patients with chronic pancreatitis
The best medical follow-up plan should be regular follow-up at the gastroenterologist’s office, and the treatment plan should be adjusted according to the severity of the disease.
For patients who are not capable of regular follow-up, they should be followed up at least once every 1-2 years if their condition is stable, and the frequency of follow-up should be increased for patients who have been suffering from the disease for more than 15 years.
In case of recurrent symptoms, patients should be seen as soon as possible and, if necessary, in an emergency.
What is the prognosis of chronic pancreatitis? Can it become cancerous?
Chronic pancreatitis is a disease with a long course, complex condition, many complications and difficult to cure, active treatment can relieve the symptoms, but the prognosis is affected by various factors such as causative factors, complications and severity, treatment plan and efficacy. Current effective medical treatment can effectively improve the nutritional status of patients, while helping to prolong survival. Surgical treatment can improve the quality of survival of patients. Some studies have found that most patients die from complications of smoking, alcohol abuse and other adverse modalities as well as extra-pancreatic cancer and cardiovascular disease.
Chronic pancreatitis is currently considered a risk factor for pancreatic cancer. lowenfels et al. had a multicenter, long-term follow-up of chronic pancreatitis and found that the incidence of pancreatic cancer was 1.8% and 4% 10 and 20 years after the diagnosis of pancreatitis, respectively. However, the mechanism of CP carcinogenesis remains unknown.
How to perform psychological adjustment for patients with chronic pancreatitis
As a patient, effective psychological adjustment is very important, and the main points are.
1, fully grasp the knowledge of the disease, know yourself and your enemy.
2.Establish confidence and face it positively.
3, bad emotions in time to discharge.
Although the disease is torturous, but most patients with chronic pancreatitis can maintain a good quality of life as long as they adhere to good habits and active treatment.