Chronic pancreatitis is ongoing inflammation that slowly destroys the pancreas, most often from long-term heavy alcohol use and smoking. The gland loses its ability to make digestive enzymes and insulin, leading to poor digestion and diabetes.
Key symptoms
- Recurring or constant upper belly pain going to the back
- Pain worse after eating
- Greasy, foul-smelling, floating stools
- Weight loss and signs of diabetes such as thirst and frequent urination
What you find on exam
- Upper abdominal tenderness, often mild
- Weight and signs of poor nutrition
- Jaundice if scarring narrows the bile duct
- Signs of alcohol use or liver disease
Tests
- CT or MRI with MRCP: calcifications, duct changes and atrophy
- Fecal elastase to check enzyme function
- HbA1c or fasting glucose for diabetes
- Vitamin levels A, D, E and K; lipase is often normal
Treatment basics
- Stop alcohol and smoking completely
- Pancreatic enzyme replacement such as pancrelipase with meals
- Pain control with acetaminophen and NSAIDs first, avoiding long-term opioids when possible
- Treat diabetes and replace fat-soluble vitamins; endoscopy or surgery for duct blockage
Red flags
- Unexplained weight loss or new jaundice, concerning for pancreatic cancer
- Severe pain with vomiting suggesting an acute flare
- Vomiting blood or a new mass from a pseudocyst
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.