In 1995, Yoshida proposed the term<unk> " for the first time.<unk>  is also known as primary inflammatory pancreatitis, lymphoplasmacytic sclerosing pancreatitis, pseudotumorous pancreatitis, chronic pancreatitis with irregular narrowing of the main pancreatic duct, idiopathic chronic pancreatitis, and nonalcoholic duct destructive chronic pancreatitis.<unk>  <unk>  may be classified into two types; type 1<unk>  and type 2<unk>  or idiopathic duct-centric pancreatitis. Type 1 <unk>  meets the HISORt criteria, involves pancreas as one part of a systemic IgG4-positive disease. Type 2 consists of granulocytic lesions, does not involve IgG4-positive cells, has no systemic involvement, and is usually associated with inflammatory bowel disease. Th1-type CD4+ T cells are thought to play an important role in the pathogenesis of<unk>  <unk>  via<unk>  reaction against carbonic anhydrase type II or lactoferrin.<unk>  may be associated with systemic<unk>  conditions such as IgG4-associated cholangitis, chronic sclerosing sialadenitis (Küttner's tumor), Mikulicz's disease (IgG4-related plasmacytic exocrinopathy), mediastinal fibrosis, adenopathy, chronic periaortitis, idiopathic retroperitoneal fibrosis, tubulointerstitial nephritis, IgG4-associated pseudolymphoma, ulcerative colitis and hypergammaglobulinemia. Diffuse pancreatic gland enlargement may be seen on gross examination. Microscopic findings suggestive of<unk>  may include Interlobular ducts surrounded by the infiltration of inflammatory cells and fibrosis. Immunohistochemistry stains may show CD4+ T cells (mainly), some CD8+ T cells, B cells and HLA-DR antigen expression on pancreatic duct or acinar cells.<unk>  is idiopathic in origin and has no clear etiology.<unk>  is thought to be due to some<unk>  reaction against pancreas and might be associated with other<unk>  diseases.<unk>  needs to be differentiated from other diseases such as alcoholic chronic pancreatitis, pancreatic cancer, chronic pancreatitis, inflammatory bowel disease, dumping syndrome, celiac disease, Whipple's disease, tropical sprue and colon carcinoma. In North America, 2.5% of pancreatoduodenectomies are done because of<unk>  being misdiagnosed as pancreatic cancer. The symptoms of<unk>  usually develop in the fifth decade of life, and start with symptoms such as painless jaundice, dark urine, and mild abdominal pain. During the later course of disease, patients may present with abdominal mass mimicking pancreatic cancer. If left untreated, patients with<unk>  may progress to develop pancreatic insufficiency, diabetes, and pancreatic calcifications or stones. The prognosis is usually good; about 2/3rd of patients show good response to glucocorticoids with complete recovery, 25% may require a second course of glucocorticoids, and a few patients with<unk>  may require continuous treatment.<unk>  is diagnosed by revised HISORt criteria, proposed by Mayo clinic, that includes histology, pancreatic imaging, serology, other organ involvement, and response to steroid treatment. Patients with<unk>  may do not have a positive history of alcohol abuse. Common symptoms of<unk>  include mild abdominal pain, abdominal mass/pancreatic mass, painless jaundice, weight loss, and diabetes mellitus. Laboratory findings consistent with the diagnosis of<unk>  may include increased serum IgG4 levels and hypergammaglobulinemia (>2 times the upper limit of normal in most patients), antilactoferrin antibody, anticarbonic anhydrase II antibody, other autoantibodies (ANA), rheumatoid factor (RF), IgG4-positive plasma cells, elevated serum alkaline phosphatase levels (ALP), elevated serum aminotransferases, ESR, and CA19-9. CT scan findings suggestive of<unk>  may include diffusely enlarged pancreas with featureless borders, delayed enhancement with or without a capsule-like rim and rarely calcifications may be seen. ERCP or MRCP findings in<unk>  may include a narrowed main and dorsal pancreatic duct, diffuse and irregular narrowing of the pancreatic duct (beaded appearance), focal stricture of the pancreatic duct, proximal or distal common bile duct and irregular narrowing of the intrahepatic ducts. Glucocorticoids are found to play an important role in the management of<unk>  via several ways such as efficacy in alleviating symptoms, decreasing the size of the pancreas, reversing histopathologic features in patients with<unk> ,  and mprovement of lab findings. Immunomodulatory drugs such as azathioprine are usually used when,<unk>  patients have no response to steroid management, relapse occurs and patients cannot be weaned off steroids. Surgery is usually considered when pain management fails with medical and endoscopic therapies. The goals of surgery include effective pain relief, and to preserve long-term pancreatic function. Surgery for chronic pancreatitis tends to be divided into two areas - resectional and drainage procedures. Dilated pancreatic duct may be managed with lateral pancreaticojejunostomy (LPJ) and lateralpancreaticojejunostomy with localized pancreatic head resection. Nondilated pancreatic duct is usually managed with pancreaticoduodenectomy, duodenal-preserving pancreatic head resection (DPPHR), distal pancreatectomy (DP) and total pancreatectomy (TP). Patients should be managed appropriately and timely with glucocorticoids and immunomodulatory drugs to prevent complications such as pancreatic insufficiency, diabetes, and pancreatic calcifications or stones.
Autoimmune pancreatitis
Hereditary pancreatitis
Chronic pancreatitis
Juvenile tropical pancreatitis syndrome
Chronic cholecystitis
Biliary fistula
Gallbladder volvulus
Gallstone pancreatitis