Clinical features

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

1. Gardner TB, Adler DG, Forsmark CE, et al. ACG clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020 Mar;115(3):322-39.