Kronik Pankreatitin Kliniği ve Ayırıcı Tanısı
Özet
Kronik pankreatit, pankreasın tekrarlayan iltihaplanma atakları sonucu kalıcı hasar gördüğü, ekzokrin ve endokrin fonksiyon kayıplarıyla seyreden patolojik bir süreçtir. En belirgin klinik semptom olan karın ağrısı, genellikle epigastrik bölgede hissedilip sırta yayılmakta ve hastaların yaşam kalitesini ciddi şekilde bozmaktadır. Hastalık ilerledikçe, sindirim enzimlerinin eksikliğine bağlı steatore (yağlı dışkılama) ve kilo kaybı gelişirken, endokrin hasar sonucunda pankreatojenik diyabet ortaya çıkabilmektedir. Teşhis sürecinde amilaz ve lipaz gibi laboratuvar bulguları özellikle ileri evrelerde düşük duyarlılığa sahip olduğundan; bilgisayarlı tomografi (BT), MRKP ve endoskopik ultrason (EUS) gibi kesitsel görüntüleme yöntemleri kritik rol oynar. Ayırıcı tanıda ise pankreas adenokarsinomu, kistik neoplazmalar ve IPMN gibi tıkayıcı lezyonların dışlanması hayati önem taşımaktadır. Erken evrelerde tanı koymak, osteoporoz, psödokist ve ven trombozu gibi komplikasyonların yönetimi ile prognozu iyileştirmek için temel hedeftir.
Chronic pancreatitis is a pathological process characterized by permanent pancreatic damage due to recurrent inflammatory episodes, leading to exocrine and endocrine dysfunction. Abdominal pain, the most common clinical symptom, typically manifests in the epigastric region radiating to the back and significantly impairs patients' quality of life. As the disease progresses, malabsorption (steatorrhea) and weight loss develop due to digestive enzyme deficiencies, while endocrine damage results in pancreatogenic diabetes. In the diagnostic process, laboratory findings such as amylase and lipase have low sensitivity, especially in advanced stages; therefore, cross-sectional imaging modalities like computed tomography (CT), MRCP, and endoscopic ultrasound (EUS) play a critical role. In differential diagnosis, excluding obstructive lesions such as pancreatic adenocarcinoma, cystic neoplasms, and IPMN is of vital importance. Early diagnosis remains the primary goal to improve prognosis through the management of complications such as osteoporosis, pseudocysts, and venous thrombosis.
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