Chronic Pancreatitis Clinical Presentation

Updated: Sep 26, 2016
  • Author: Jason L Huffman, MD; Chief Editor: BS Anand, MD  more...
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Presentation

History

For most patients with chronic pancreatitis, abdominal pain is the presenting symptom. Either the patient's age or the etiology of the disease has some influence on the frequency of this presentation. Ninety-six percent of those with early onset idiopathic pancreatitis present with abdominal pain, compared with 77% with alcohol-induced disease and 54% with late-onset idiopathic chronic pancreatitis.

Clinically, the patient experiences intermittent attacks of severe pain, often in the midabdomen or left upper abdomen and occasionally radiating in a bandlike fashion or localized to the midback. The pain may occur either after meals or independently of meals, but it is not fleeting or transient and tends to last at least several hours. Unfortunately, patients often are symptomatic for years before the diagnosis is established; the average time from the onset of symptoms until a diagnosis of chronic pancreatitis is 62 months. The delay in diagnosis is even longer in people without alcoholism, in whom the average time is 81 months from the onset of symptoms to diagnosis.

The natural history of pain in chronic pancreatitis is highly variable. Most patients experience intermittent attacks of pain at unpredictable intervals, while a minority of patients experience chronic pain. In most patients, pain severity either decreases or resolves over 5-25 years. Nevertheless, ignoring pain relief with the expectation that the disease eventually will resolve itself is inappropriate. In alcohol-induced disease, eventual cessation of alcohol intake may reduce the severity of pain. Variability in the pain pattern contributes to the delay in diagnosis and makes determining the effect of any therapeutic intervention difficult.

Other symptoms associated with chronic pancreatitis include diarrhea and weight loss. This may be due either to fear of eating (eg, postprandial exacerbation of pain) or due to pancreatic exocrine insufficiency and steatorrhea.

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Physical Examination

In most instances, the standard physical examination does not help to establish a diagnosis of chronic pancreatitis; however, a few points are noteworthy.

During an attack, patients may assume a characteristic position in an attempt to relieve their abdominal pain (eg, lying on the left side, flexing the spine and drawing the knees up toward the chest).

Occasionally, a tender fullness or mass may be palpated in the epigastrium, suggesting the presence of a pseudocyst or an inflammatory mass in the abdomen. Patients with advanced disease (ie, patients with steatorrhea) exhibit decreased subcutaneous fat, temporal wasting, sunken supraclavicular fossa, and other physical signs of malnutrition.

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