Severe disease may develop before symptoms are evident. In the West most patients have a history of prolonged and heavy alcohol use.
Clinical features of chronic pancreatitis may include:
- abdominal pain - mainly epigastric and upper abdominal; may radiate to the back. The pain is variable and may be severe. It may be continuous and difficult to distinguish from that of pancreatic carcinoma; or may be episodic, often, but not always, precipitated by alcohol.
- anorexia and weight loss - due to malabsorption and / or small meals
- features of exocrine insufficiency:
- steatorrhoea - occurs in about 50% of patients; can be minimal in patients who reduce their fat intake
- hypocalcaemia - unabsorbed fat chelates calcium
- malabsorption of fat - but malabsorption of fat soluble vitamins rarely produces symptoms such as bleeding tendency
- protein catabolism - protein malabsorption due to deficiency of pancreatic proteases - exacerbates weight loss
- features of endocrine insufficiency:
- impaired glucose tolerance
- eventually, frank diabetes
- other features:
- obstructive jaundice
- portal hypertension from splenic or portal vein thrombosis
- pancreatic duct strictures
Examination reveals epigastric tenderness; rarely, a mass.
Reference
- Gardner TB, Adler DG, Forsmark CE, et al. ACG clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020 Mar;115(3):322-39.