A 45-year-old patient complains of pain in the epigastric region, left subcostal area, abdominal distension, diarrhea, loss of weight. He has been suffering from this condition for 5 years. Objectively: the tongue is moist with white coating near the root; deep palpation of abdomen reveals slight pain in the epigastric region and Mayo-Robson's point. Liver is painless and protrudes by 1 cm from the costal arch. Spleen cannot be palpated. What disease can be primarily suspected?

Answer options

1. Chronic enteritis
2. Chronic cholecystitis
3. Atrophic gastritis
4. Chronic pancreatitis
5. Peptic stomach ulcer

Explanation

Chronic pancreatitis is a progressive inflammatory disease in which there is an irreversible destruction of pancreatic tissue. Its clinical course is characterized by severe pain and, in the later stages, exocrine and endocrine pancreatic insufficiency. In the initial stages of its evolution, it is frequently complicated by attacks of acute pancreatitis, which are responsible for the recurrent pain that may be the only clinical symptom. 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 in more than 30 % of patients with chronic pancreatitis. Bailey & Love’s short practice of surgery – 27th edition – P.1230