Most individuals with chronic pancreatitis experience upper abdominal pain, although some have no pain at all. The pain may spread to the back, become worse with eating or drinking, and become constant and disabling. In some cases, the abdominal pain goes away as the condition worsens, but this is fairly uncommon. Other symptoms include the following:
Oily or fatty stools
Clay-colored or pale stools
Individuals with chronic pancreatitis frequently lose weight, even when their appetite and eating habits are normal. The weight loss occurs because the body does not secrete enough pancreatic enzymes to digest food, so nutrients are not absorbed normally, leading to malnutrition.
Patients who have chronic pancreatitis may have a decreased quality of life due to pain and often require admission to the hospital for treatment of symptoms.
Diagnosis is based on tests of pancreatic structure and function. Imaging studies such as abdominal radiography and CT scanning can show inflammation or calcium deposits in the pancreas or changes in the pancreatic ducts. Pancreatic calcifications, often considered pathognomonic of chronic pancreatitis, are observed in approximately 30% of cases.
The endoscopic retrograde cholangiopancreatography (ERCP) test provides the most accurate visualization of the pancreatic ductal system and has been regarded as the criterion standard for diagnosing chronic pancreatitis. It combines the use of endoscopy and fluoroscopy to visualize and treat problems of the biliary and pancreatic ducts.
Magnetic resonance cholangiopancreatography provides information on the pancreatic parenchyma and adjacent abdominal viscera, and it uses heavily T2-weighted images to visualize the biliary and pancreatic ductal systems. This procedure is relatively safe, reasonably accurate, noninvasive, fast, and very useful in planning surgical or endoscopic intervention.
The most predictive endosonographic feature of chronic pancreatitis is the presence of stones. Other suggestive features include the following:
Visible side branches
An irregular main pancreatic duct
Hyperechoic foci and strands
Dilation of the main pancreatic duct
Hyperechoic margins of the main pancreatic duct