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Transcript
Internal Medicine
Signs and symptoms:
•
Persistent or recurrent epigastric or left upper abdominal pain, nausea, vomiting,
anorexia, constipation, flatulence and weight loss are common.
•
In advanced disease, patients may develop steatorrhea, recurrent acute attacks of
pain which become more constant later and insulin secretion is diminished with
impaired glucose tolerance.
Diagnosis:
•
Laboratory tests are frequently normal, but inflammation markers may be
minimally elevated.
•
Plain abdominal x-ray may demonstrate pancreatic calcification in 30% of cases
•
Abdominal ultrasound or CT to detect calcifications, dilated ducts and atrophic
gland
•
ERCP is most sensitive test and may show dilated ducts, intraductal stones,
strictures or pseudocyst
•
Tests of pancreatic function: assess endocrine and exocrine function, including
glucose tolerance test (see chapter on diabetes mellitus). For exocrine function do
ecretin test.
•
Stool tests: faecal chymotrypsin
Treatment
•
Alcohol intake should be avoided.
•
At times, IV fluids and fasting prove beneficial.
•
Use of oral pancreatic enzymes (30.000 U of lipase) with each meal may improve
symptoms.
•
If steatorrhea is particularly severe and refractory, medium chain triglycerides,
which are absorbed without pancreatic enzymes, can be provided as an alternative
source of fat.
•
Supplementation with fat-soluble vitamins (A, D, K) is sometimes required.
•
Relapse may require treatment similar to that of acute pancreatitis.
•
A pancreatic pseudocyst, which causes chronic pain, needs referral to centres with
surgical facilities and expertise, where it can be decompressed into a nearby
structure to which it firmly adheres (e.g., the stomach) or into a defunctionalized
loop of jejunum.
363