Pancreatitis, Chronic - Manifestations & Diagnosis

• Can have a wide range of symptoms, from fairly asymptomatic with signs of pancreatitic insufficiency without pain,  to recurrent bouts of epigastric pain and nausea/vomiting.

• Most common cause is alcoholism causing recurrent damage and scarring of the pancreas

• Classic triad is 1) Pancreatic calcifications on imaging, 2) Steatorrhea, and 3) Diabetes.  But note that these are typically seen in late, advanced disease.

• Diagnosis can be difficult, since patients usually have normal lipase and amylase levels (even when presenting with flares) and signs of pancreatic insufficiency come much later.  Pancreatic calcifications are only seen in ~30% of plain radiographs, although CT and MRCP substantially increase the sensitivity.  Demonstrating steatorrhea with a 72 hour quantitive fecal fat can be helpful, as can checking fecal elastase levels, but lack of these findings does not preclude the diagnosis.

(Chanu Rhee MD, 11/11/10)