<unk>  is a long-standing inflammatory disease of the pancreas characterized by irreversible changes in pancreatic structure and function leading to inflammation and fibrosis. The concept of pancreas and pancreatic duct was first described by Johannes Wirsung of Padua in 1642. The classification systems that have been used up til now for<unk>  include; Marseille, Marseille-Rome, Cambridge, TIGAR-O, ABC grading system, and Manchester system. The pathogenesis is still unclear and multifactorial but decreased bicarbonate secretion and intrapancreatic activation of digestive enzymes is thought to play an important role in the pathogenesis of<unk> . Other factors that are thought to play an important role in the pathogenesis of<unk>  may include intraductal plugging and obstruction, direct injury to pancreatic cells induced by toxins and toxic metabolites, antioxidants, ischemia, autoimmune disorders, the sentinal acute pancreatitis event (SAPE) hypothesis, necrosis and fibrosis. Genes involved in the pathogenesis of<unk>  include CFTR-cystic fibrosis gene mutation, SPINK-1, which encodes for trypsin inhibitor, PRSS-1 gene linked to hereditary pancreatitis, claudin-2 (CLDN2), and carboxypeptidase A1 <unk> A1) genes. TIGAR-O may be used for the etiologic classification of<unk> .<unk>  needs to be differentiated from other diseases presenting with similar complaints such as abdominal pain, diarrhea, and weight loss. The incidence of<unk>  and the number of hospital admissions secondary to<unk>  is increasing in most countries worldwide. Alcoholic pancreatitis is more prevalent in developed or industrialized countries. Idiopathic and tropical pancreatitis is more prevalent in developing and underdeveloped countries. The M-ANNHEIM multiple risk factor classification of<unk>  includes multiple risk factors such as alcohol consumption, nicotine consumption, nutritional factors, hereditary factors, efferent duct factors, immunological factors, rare metabolic factors, and miscellaneous factors. The risk of progression of<unk>  to pancreatic cancer is approximately 4% at 20 years. Common complications of<unk>  usually include pseudocyst formation and mechanical obstruction of the duodenum and common bile duct. The diagnostic study of choice for<unk>  is magnetic resonance cholangiopancreatography (MRCP). The diagnosis is difficult to establish as the laboratory results and the imaging may be normal. Patients with<unk>  usually present with persistent abdominal pain with episodic flares that may or may not be associated with food intake, steatorrhea, pancreatic diabetes, nausea and weight loss. A secretin stimulation test is considered the gold standard functional test for diagnosis of<unk> . Fecal tests may include sudan staining of feces, 72-hour quantitative fecal fat (gold standard), and faecal elastase measurement (test of choice). CT scan findings suggestive of<unk>  may include dilatation of the main pancreatic duct, calcifications, pancreatic gland enlargement, changes in pancreatic size, shape, and contour, and pancreatic pseudocysts. MRI findings may include parenchymal atrophy or enlargement, pseudocyst formation, dilatation and beading of the pancreatic duct with intraductal calcifications giving an appearance of 'chain of lakes'.  ERCP findings diagnostic of<unk>  may include beaded appearance of the main pancreatic duct and ectatic side branches from the main pancreatic duct. Presence of stones is the most predictive finding seen on endoscopic ultrasonography. Other diagnostic studies may include genetic testing such as CFTR-Cystic fibrosis gene mutation, SPINK-1, which encodes for trypsin inhibitor and PRSS-1 gene linked to hereditary pancreatitis. Medical therapy includes pancreatic enzyme supplementation, analgesics and antioxidants. Specialized approaches include celiac nerve block, endoscopic therapy, extracorporeal shock wave lithotripsy (ESWL), and radiation. Steatorrhea can be managed by dietary modification, lipase supplementation, vitamin supplementation, and medium chain triglycerides (MCTs). Surgery for<unk>  tends to be divided into two resectional and drainage procedures. Dilated pancreatic duct may be managed with lateral pancreaticojejunostomy (LPJ) and lateral pancreaticojejunostomy with localized pancreatic head resection. Nondilated pancreatic duct is usually manages with pancreaticoduodenectomy, duodenal-preserving pancreatic head resection (DPPHR), distal pancreatectomy (DP) and total pancreatectomy (TP).
Chronic pancreatitis
Chronic cholecystitis
Hereditary pancreatitis
Autoimmune pancreatitis
Gallstone pancreatitis
Acute cholecystitis
Gallstone disease
Pancreatic abscess