Case history
Case history
A 41-year-old man with alcohol use disorder has a 6-year history of recurrent attacks of pancreatitis characterised by epigastric pain radiating to the back. The initial attack required hospitalisation for severe pain, and clinical chemistry showed a >15-fold elevation in serum amylase and lipase. Subsequent attacks were less severe, managed primarily as an outpatient, and lasted less than 10 days, with long symptom-free intervals. After detoxification 6 months ago he had no further attacks, but has recently developed evidence of diabetes and steatorrhoea. Computed tomography imaging shows pancreatic calcifications but no cystic or mass lesions.
Other presentations
In older patients, particularly with imaging findings of a 'mass-like' appearance, important considerations include late-onset idiopathic chronic pancreatitis, autoimmune pancreatitis, and pancreatic cancer.[7] In late-onset idiopathic chronic pancreatitis, the salient features are weight loss, steatorrhoea, and pancreatic calcifications. Only 50% of patients complain of pain. Patients who have autoimmune pancreatitis present commonly with obstructive jaundice, weight loss and, rarely, abdominal pain, and often have a concomitant autoimmune disorder: for example, diabetes mellitus.[8][9] In young patients, juvenile idiopathic chronic pancreatitis should be considered. This usually presents with recurrent attacks of pancreatitis, and up to 50% may have a genetic mutation such as a cystic fibrosis transmembrane conductance regulator and/or a serine protease inhibitor Kazal-type 1 gene mutation.
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