Synopsis
Diagnose irreversible pancreatic disease, treat pain without stigma, replace exocrine function, detect type 3c diabetes and malnutrition, and select duct or cancer pathways safely.
- Chronic pancreatitis is progressive fibro-inflammatory pancreatic damage causing recurrent or persistent upper-abdominal pain, ductal or calcific structural change and eventual exocrine or endocrine failure.
- Do not assume alcohol causation because a person drinks: smoking, genetic variants, autoimmune disease, recurrent acute episodes, obstruction, anatomical factors and metabolic disease require consideration.
- CT demonstrates calcification, atrophy, duct dilatation, stones, pseudocyst and mass; MRI/MRCP and EUS help when early or ductal disease remains uncertain and the result would change care.
Key red flags
Progressive jaundice, rapid unexplained weight loss, a new mass, gastrointestinal bleeding, fever, persistent vomiting or substantially altered pain requires urgent re-imaging and specialist review.
Investigation priorities
Assess calcification, atrophy, duct enlargement, stones, inflammatory mass, pseudocyst, obstruction and possible malignancy.
Management branches
Symptoms, nutritional decline or testing supports pancreatic exocrine insufficiency.
- Refer to a pancreatic-experienced dietitian and document stool, intake, weight, muscle, alcohol, smoking, vitamins and alternative malabsorption diagnoses.
- Start an available enteric-coated pancreatin product with all meals and snacks, teaching the person to spread the prescribed amount through eating.
Key medicines
Enteric-coated pancreatin replacementPrescribe an individual lipase-based amount with every meal and snack, spread through eating and titrated using current BNF and specialist guidance.
Proton-pump inhibitor adjunctUse a standard current BNF adult regimen as a specialist-informed trial when adequate correctly timed pancreatin remains clinically ineffective.