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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.
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
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
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
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.