Because the acini secrete pancreatic enzymes necessary for the digestion of proteins, carbohydrates, and fats, dysfunction of acinar tissue results in malabsorption of nutrients from the small intestine. The patient may complain of bulky, fatty, foul-smelling stools, weight loss, fever, malaise, and nausea and vomiting. There also can be a negative nitrogen balance resulting in wasting of the muscles, and malabsorption of the fat-soluble vitamins resulting in easy bruising and bleeding from mild injury. Inadequate absorption of calcium and vitamin B 12 also can occur. Glucose intolerance due to insulin lack resulting from degeneration of the islets of Langerhans is a late manifestation of chronic pancreatitis.
Treatment is chiefly substitutive and palliative.
Pancreatic insufficiency can be treated with the administration of pancreatic extract with each meal. Relief of pain is not so easily accomplished and often necessitates the use of addictive narcotic analgesics such as codeine, morphine, and meperidine. Symptomatic relief can make the patient more comfortable and substitutive therapy can help maintain adequate nutrition and strengthen the patient's resources so that he can continue most everyday activities of living, but there is no cure for chronic pancreatitis and the long-term prognosis is not good. Pancreatectomy and islet cell autotransplantation are being done experimentally as an alternative mode of therapy for patients who continue to have chronic pancreatitis. Oral replacement of digestive enzymes and management of diabetes mellitus are necessary after the pancreas is removed.