Clinical Features
Acute pancreatitis
The main symptom of acute pancreatitis is the sudden onset of very severe upper abdominal pain radiating to the back. This is accompanied by nausea, vomiting and abdominal distension; it is aggravated by eating and drinking. In severe cases there may be collapse, respiratory distress and kidney failure. In milder cases and in older people there may be less pain and distress with a slower onset.
On examination the abdomen is distended, tender to palpation and normal bowel sounds are absent; the person may be mildly jaundiced (yellow coloration of the skin and eyes).
The diagnosis is based on the clinical features, blood tests (specifically amylase level), x rays, ultrasound scan, Computerised Tomography (CT) or Magnetic Resonance Imaging (MRI) scan. Pancreatic amylase, one of the digestive enzymes made by the pancreas, can be identified in the blood in high concentrations within hours of the onset of the acute attack.
Usually people with acute pancreatitis are admitted to hospital to confirm the diagnosis, to provide adequate pain relief and to monitor and stabilise their condition. The majority of cases are self limiting and spontaneous recovery of the pancreas occurs. In severe cases however mortality may be up to 5%.
Chronic pancreatitis
The main symptom of chronic pancreatitis is abdominal pain. It varies much in its pattern and severity between different individuals, and whether it occurs frequently, persistently or episodically. It is often worsened by eating and leads to significant weight loss if food intake is decreased. Characteristically it is worse at night.
With time a percentage of people develop diarrhoea and steatorrhoea (the passage of frequent, soft, mal odorous pale fatty faeces) due to inadequate digestion and absorption of foodstuffs in the intestine (malabsorption). Inadequate digestion of food also leads to weight loss, malnutrition and vitamin and mineral deficiencies. About 15% of people with chronic pancreatitis may present only with diarrhoea, steatorrhoea and weight loss, and never have abdominal pain.
Clinical examination may reveal little abnormality in those whose main symptom is abdominal pain. Some attacks of the condition may be accompanied by jaundice. With time most people tend to lose weight .Some people with significant malabsorption may show marked weight loss and loss of muscle bulk.
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Amended April 2008
