A 53-year-old woman complains of weight loss up to 10 kg within the last 2 years, liquid foul-smelling stool two times a day that poorly washes off the toilet, periodic bouts of nausea, girdle pain in the upper abdomen. Objectively: pain in Gubergrits zone (on the right from navel) and Mayo-Robson’s point. Biochemical blood analysis: glucose - 3,2 mmol/l, bilirubin -16,5 micromole/l, crude protein - 56,4 g/l. Urine diastase - 426 g/h/l. D-xylose test (oral administration of 25 g of d-xylose) after 5 hours reveals 3 g of xylose in urine. The most likely diagnosis is:

Answer options

1. Pancreatitis. Malabsorption syndrome
2. Chronic gastritis
3. Irritable bowel syndrome
4. Nonspecific ulcerative colitis
5. Pseudomembranous colitis

Explanation

Pain is an outstanding symptom in most patients. The site of pain depends on the focus of the disease. If the disease is in the head of the pancreas, then epigastric and right subcostal pain is common, whereas if it is limited to the left side of the pancreas, left subcostal and back pain are the presenting symptoms. In some patients, the pain is more diffuse. Radiation to the shoulder can occur. The pain is often dull and gnawing. Severe flare-ups of pain may be superimposed on background discomfort. Weight loss is common because the patient does not feel like eating. The patient’s lifestyle is gradually destroyed by pain, analgesic dependence, weight loss, and inability to work. Loss of exocrine function leads to steatorrhea (liquid foul-smelling stool, that poorly washes off the toilet) in more than 30% of patients with chronic pancreatitis. Loss of endocrine function and the development of diabetes are common, and the incidence increases as the disease progress. Bailey & Love’s short practice of surgery. – 27th edition. – P. 1230.