Chronic fibro-inflammatory disease of the pancreas, resulting in progressive and irreversible damage to the pancreatic parenchyma; damage results in loss of exocrine +/- endocrine function

Aetiology

• Chronic alcohol abuse - 60-80%
• Idiopathic
• Pancreatic duct obstruction (congenital or acquired)
• Autoimmune
• Tropical countries - areas deficient in methionine, zinc and selenium
• Hereditary - cystic fibrosis, ⍺1-antitrypsin

Clinical features

• Chronic epigastric/back pain
• Pain often associated with nausea and vomiting
• Endocrine insufficiency - impaired glucose regulation or eventual diabetes mellitus
• Exocrine insufficiency - malabsorption (weight loss, diarrhoea, steatorrhoea)
• Often concurrent psudocysts are present due to previous recurrent attacks of acute pancreatitis - patients may present with symptoms of mass effect e.g. biliary obstruction or gastric outlet obstruction

Investigations

• CT pancreas: pancreatic calcification or atrophy, pseudocysts
• MRCP: if CT findings inconclusive
• AXR: pancreatic calcifications (highly specific but only seen in ~30% of cases)
• USS
• ECRP: distorted pancreatic ducts