Symptoms of chronic pancreatitis

Symptoms of chronic pancreatitis in children are variable and depend on the duration of the disease, the form and stage of development of the disease, the degree of disorder of the external and internal secretory functions of the gland, the presence of concomitant pathology of other organs. Despite the variety of clinical symptoms of pancreatitis, the leading syndrome is considered to be pain.

Paroxysmal pains in the upper abdomen, epigastric region (77%), right and left hypochondrium (58%) are typical. In 10% of children, the pains are aching, intensify after meals and in the afternoon, and are most often caused by a violation of the diet (coarse, fatty, fried, sweet, cold food, carbonated drinks), significant physical exertion, and viral diseases. Pain crises last from 1 to 2-3 hours, less often 4-5 hours or up to several days. Irradiation of pain to the back, left and right half of the chest is noted, sometimes the sensations acquire a girdle-like character (56%). The attack, as a rule, weakens in a sitting position with the body tilted forward in the knee-elbow position.

Another group of symptoms of chronic pancreatitis are dyspeptic disorders. The most typical are loss of appetite (78%), vomiting that occurs at the height of the pain crisis, nausea, belching, heartburn, flatulence. Constipation (38%) or loose stool (24%) are not uncommon. During the manifestation of the disease, 30% of patients experience a weight loss of 5 to 10 kg.

Usually the disease is accompanied by asthenovegetative syndrome: patients complain of fatigue, headache, emotional lability, irritability. In some patients, severe pain syndrome is accompanied by an increase in body temperature, inflammatory changes in the blood.

During an exacerbation of pancreatitis, distinct pain is detected in the projection area of the head, body or tail of the pancreas. For children, diffuse pain is characteristic in several areas at the same time: epigastric, right and left hypochondrium, in the projection of the duodenum. Pathological symptoms of Kach, Mayo-Robson are recorded, cystic symptoms, moderate enlargement of the liver are detected.

As a rule, the specific features of clinical symptoms are determined by the severity of chronic pancreatitis. The severe form is characterized by prolonged, severe pain crises localized throughout the entire upper abdomen with irradiation and various dyspeptic disorders. The frequency and severity of exacerbations increase with the child's age. This is typical for pancreatitis that has developed against the background of severe organic changes in the duodenum (duodenostasis, diverticula, stenosing papillitis, arteriomesenteric compression, etc.) and in the biliary tract (cholelithiasis, ductal system anomalies). Complications may develop (false cysts, left-sided pleurisy, pancreolithiasis, gastroduodenal erosions and ulcers, abscesses, symptoms of cholestasis, diabetes mellitus, etc.).

In moderate form, the clinical picture of pancreatitis is less pronounced, the course is relatively favorable. Pain syndrome occurs periodically after diet violations, physical overwork. Pain is usually localized in the epigastrium, left hypochondrium, sometimes intensifies to sharp pain attacks, but quickly stops. Dyspeptic disorders are moderately expressed.

In mild form, pain is usually short-term, aching or paroxysmal. Local pain is localized mainly in the projection of the pancreas, without irradiation. The prognosis for this form of pancreatitis is favorable.

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