Clinical Features of Chronic Pancreatitis

Abstract

The clinical features of chronic relapsing pancreatitis as typified by alcoholic pancreatitis may be identical to acute pancreatitis as typified by biliary tract disease. The reader is referred to Chapter 5 for a full discussion. The relationship of pain to alcohol consumption is variable. Some patients claim no recent alcohol ingestion whatsoever, some have clearly ingested alcohol in an effort to relieve the pain of pancreatitis, and others have clearly consumed alcohol and then experienced an episode of pancreatitis. The time lag may be variable. One interesting pattern that has been observed is the development of pain during the afternoon following an evening of heavy alcohol consumption.¹ This prolonged latent period cannot be explained on the basis of the known metabolic and physiologic effects of alcohol. Another interesting observation is that in severe chronic pancreatitis pain may recur after consumption of only modest amounts of alcohol whereas in earlier years considerably more alcohol was required. The explanation for this phenomenon may involve the progressive blockade of pancreatic ductules in severe chronic pancreatitis such that eventually any stimulus of pancreatic secretion, even a relatively weak one such as alcohol, causes pain on the basis of ductal distention.