Clinical manifestations and diagnosis of chronic pancreatitis in adults
- Steven D Freedman, MD, PhD
Steven D Freedman, MD, PhD
- Professor of Medicine
- Harvard Medical School
Chronic pancreatitis is a syndrome involving progressive inflammatory changes in the pancreas that result in permanent structural damage, which can lead to impairment of exocrine and endocrine function . This disorder contrasts with acute pancreatitis, which is an acute inflammatory response to pancreatic injury and is usually nonprogressive, although the two conditions may overlap. Recurrent episodes of acute pancreatitis may lead to chronic pancreatitis over time.
Chronic and acute pancreatitis can be distinguished by several features.
●Chronic pancreatitis may be asymptomatic over long periods of time, can present with a fibrotic mass, or there may be symptoms of pancreatic insufficiency without pain. Acute pancreatitis is almost always painful.
●The serum amylase and lipase concentrations tend to be normal in patients with chronic pancreatitis, but are almost always elevated with acute disease.
●Morphologically, chronic pancreatitis is a patchy focal disease characterized by a mononuclear infiltrate and fibrosis (picture 1). In contrast, acute pancreatitis diffusely involves a large portion of the entire pancreas with a predominantly neutrophilic inflammatory response.
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- CLINICAL MANIFESTATIONS
- Abdominal pain
- Pancreatic insufficiency
- - Fat malabsorption
- - Pancreatic diabetes
- Differential diagnosis
- Laboratory studies
- Imaging studies
- - Plain films
- - CT, MRI, and US
- - ERCP
- - Endoscopic ultrasonography
- Pancreatic function tests
- GENETIC TESTING
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS