I. Diagnostic Points

I. Diagnostic Points

(1) A history of recurrent acute pancreatitis.

(2) Recurrent or persistent upper abdominal pain radiating to the left flank, left chest, and left shoulder/back. The pain is often triggered by alcohol consumption, overeating, or a high-fat, high-protein diet, worsens when lying down, and can be alleviated by leaning forward or lying on one’s side with knees drawn up. As pancreatic fibrosis progresses, abdominal pain gradually diminishes or even disappears, but pancreatic-related diarrhea becomes increasingly severe, leading to progressive weight loss and even cachexia. Most patients also experience nausea, vomiting, loss of appetite, bloating, and belching.

(3) Pancreatic diarrhea results from insufficient pancreatic lipase secretion, leading to steatorrhea. Stools are loose, occurring more than three to four times daily, voluminous, foamy, and foul-smelling. Microscopic examination reveals fat droplets, fat crystals, and undigested fiber.

(4) Pancreatic lesions involve the islets, leading to insufficient insulin secretion and subsequent diabetes. Patients may not exhibit classic symptoms such as polydipsia, polyphagia, and polyuria; instead, they often present with gradual weight loss, fatigue, and even neurological symptoms like numbness. Elevated blood glucose or urinary glucose levels confirm the diagnosis.

(5) Physical signs: Abdominal tenderness is usually mild or absent; however, when pseudocysts develop, a round mass may be palpable in the abdomen. Significant fibrosis of the pancreatic head or compression of the lower common bile duct by a pseudocyst can result in persistent or gradually worsening jaundice.

(6) Auxiliary examinations:
① Laboratory tests: Increased serum and urine amylase levels, possibly elevated blood glucose. The glucose tolerance test curve shows a steep rise, fecal fat droplets are positive, and levels of bilirubin, cholecystokinin-pancreozymin (CCK-PZ), and pancreatic function peptide (BT-PABA) in the urine are all elevated. BT-PABA excretion in the urine is about 50% of normal.
② Ultrasound: In addition to visualizing the biliary system, it can also reveal pancreatic enlargement or shrinkage, irregular margins, localized or diffuse increased echogenic foci, and sometimes thickened pancreatic ducts or pancreatic stones. CT scans may also show pancreatic lesions.
③ X-ray: An abdominal plain film may occasionally detect pancreatic stones, while an upper gastrointestinal barium meal study might reveal gastric and duodenal compression or other associated abnormalities.
④ Endoscopic examination: Fiberoptic duodenoscopy may reveal papillary lesions, and endoscopic retrograde cholangiopancreatography can identify pancreatic duct dilatation, stenosis, and pancreatic stones.