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.
This topic review will discuss the clinical features and diagnosis of chronic pancreatitis. The etiology, pathogenesis, complications, and treatment of this disorder in adults are discussed separately. (See "Etiology of acute pancreatitis" and "Treatment of chronic pancreatitis".)
The two primary clinical manifestations of chronic pancreatitis are abdominal pain and pancreatic insufficiency.