Symptoms and Signs of ACUTE Pancreatitis
Symptomsof acute pancreatitis include (1):
- Alcoholic related acute pancreatitis usually occurs after some years of excessive daily drinking
- Gallstones related acute pancreatitis occurs mostly in old people with history of gallstones or upper right abdominal pain after the meal. This type of pancreatitis is often present with jaundice
- Constant, dull, deep, often severe pain in the upper middle abdomen (below the breastbone), that may radiate to the sides or to the back; may worsen when lying down. Rarely the pain may be on the right side or in lower abdomen (other causes of right side abdominal pain and left side abdominal pain)
- Nausea, vomiting
During physical examination, a doctor may find the following signs of acute pancreatitis:
- Tenderness and rigid muscles in the upper abdomen
- Increased heart rate
Diagnosis. Elevated pancreatic enzymes: amylase, lipase and trypsin, together with the history of alcohol abuse or gallstones is usually enough for diagnosis (1). In doubtful cases, CT may be needed.
Symptoms and Signs of CHRONIC Pancreatitis
Chronic pain, either constant or recurrent, in the upper abdomen is the main symptom. Other symptoms resemble acute pancreatitis (see above). With time, other symptoms, due to complications, may develop:
- Bulky, whitish, sticky, greasy, floating, foul smelling stool or diarrhea (steatorrhea) from undigested fats, unabsorbed due to lack of pancreatic enzymes
- Weight loss due to fat malabsorption
- Symptoms of fat soluble vitamin deficiency:
- skin peeling and night blindness, due to vitamin A deficiency
- bone pains or fractures from osteoporosis, due to vitamin D deficiency
- easy bruising, due to vitamin K deficiency
- Diabetes, due to damage of insulin producing cells
- Chronic pancreatitis is mainly caused by chronic alcoholism. In children, main causes are genetic disorders, like cystic fibrosis. Other causes of chronic pancreatitis.
Diagnosis is made from the history of repeating acute pancreatitis and chronic alcohol abuse. Pancreatic enzymes tests are not reliable (2). Stool-fat test may reveal fat malabsorption. X-ray may show calcifications (Picture 1). CT (with contrast) of abdomen may be needed in doubtful cases.
Picture 1. Chronic pancreatitis: calcifications in the pancreas (X-ray of abdomen)
Symptoms of Pancreatic CANCER
Symptoms of pancreatic cancer often appear only in its advanced stage. Risk factors are genetic predisposition, chronic pancreatitis, smoking, fat-rich diet, and age after 60. Symptoms are not specific and may include:
- Chronic upper abdominal pain (may appear only in advanced stages)
- Poor appetite
- Weight loss
Diagnosis. Blood tests often show increased liver enzymes, bilirubin and CA 19-9 marker. Cancer can be seen on CT (with contrast) of abdomen.
Pancreatic CYST Symptoms
Pancreatic cyst is an enclosed sac within the pancreas, which sometimes may be cancerous. It often triggers no symptoms but it may sometimes cause:
- Upper abdominal pain
- palpable mass in the upper abdomen
Pancreatic cysts are often found during ultrasound, CT or MRI investigations performed because of other abdominal problems. A needle aspiration of the fluid from the pancreatic cyst (performed during endoscopic ultrasound) may reveal if a cyst is cancerous or not (4).