Signs and Symptoms of Chronic Pancreatitis

There are several characteristic signs and symptoms related to chronic pancreatitis (CP) which include:

• Abdominal pain - Most patients experience abdominal pain in the epigastric area (the upper mid-portion of the abdomen) that is deep and may radiate to the back
• Unintentional weight loss - weight loss even though eating habits are normal. This is due to insufficient amounts of secreted pancreatic enzymes needed to digest the food resulting in minimal absorption of nutrients. Weight loss can also occur if the patient tries to avoid exacerbating the pain by not eating.
• Steatorrhea - Oily stools that occur when over 80% of pancreatic tissue has been destroyed or when pancreatic enzymes are reduced to less than 10% of normal.
• Nausea and vomiting
• Acute flare-up of pancreatitis seen in alcohol-induced disease, particularly in "weekend drinkers." In this situation, pain usually begins 12-48 hours after ceasing alcohol ingestion.
• Exocrine insufficiency - impairment in digestion because of impaired production of pancreatic enzymes
• Endocrine insufficiency - impairment of insulin production resulting in elevated levels of blood sugar (glucose)

Diagnostic Testing for Chronic Pancreatitis

Since chronic pancreatitis (CP) results in both functional and structural damage to the pancreas, diagnostic tests are designed to evaluate both of these factors. Pancreatic tissue biopsy is ideally the gold standard for diagnosis with a correlation of almost 100%, but there is a high risk of complications since the procedures used to sample the tissue are invasive. Doctors continue to investigate diagnostic methods that are accurate and reliable but carry minimal complications.

A typical diagnostic evaluation for chronic pancreatitis includes:

• Physical examination
• Exocrine function evaluation
• Endocrine function evaluation
• Evaluation of structural damage to the pancreas by imaging studies
• Genetic testing
• Immunological testing

A physical examination usually does not yield sufficient information for a definitive diagnosis of chronic pancreatitis but may raise the index of suspicion under the following circumstances:

• If the patient is in pain, they may assume a typical posture to relieve the pain, namely lying on their side in the fetal position (knees drawn up to chest) or sitting up and leaning forward.
• Sometimes the doctor may palpate a tender fullness in the upper abdominal area which may indicate an inflammation or a pseudocyst.
• The patient may have signs of malnutrition, including temporal wasting (indentations at the temples on the sides of the head), a decrease in subcutaneous fat (normal fat tissue under the skin), or a generalized sunken look.

This aspect of the evaluation measures the digestive enzymes for exocrine insufficiency which would indicate that the pancreas has ceased producing and secreting enough digestive enzymes.

Blood tests may be helpful for initial screening. These tests include: