The most common cause of chronic pancreatitis in adults is .
USMLE® Step 1 style questions USMLE
USMLE® Step 2 style questions USMLE
A 37-year-old man comes to the office because of an 8-month history of abdominal pain. He says the pain is in his upper abdomen, and will occasionally radiate to his back. He also occasionally has greasy stools. The patient does not smoke and has 2-3 alcoholic drinks per night. An abdominal CT scan is obtained and is shown below. Which of the following is the most likely diagnosis?
Content Reviewers:Rishi Desai, MD, MPH
Acute pancreatitis is inflammation caused by destruction of the pancreas by its own digestive enzymes—a process called autodigestion, and is generally reversible.
Chronic pancreatitis is inflammation due to irreversible changes to the pancreatic structure, like fibrosis, atrophy and calcification.
The pancreas is a long, skinny gland the length of a dollar bill and is located in the upper abdomen, or the epigastric region, behind the stomach. It plays endocrine roles—for example, alpha and beta cells make hormones like insulin and glucagon that are secreted into the bloodstream, but it also plays exocrine roles— for example, acinar cells make digestive enzymes that are secreted into the duodenum to help digest food.
These pancreatic digestive enzymes break down macromolecules like carbohydrates, lipids and proteins found in food, but these macromolecules are also found in the cells of the pancreas.
To protect the pancreas, the acinar cells manufacture inactive forms of the enzymes called proenzymes, or zymogens.
These zymogens are normally activated by proteases which cleave off a polypeptide chain, which is kind of like pulling the pin on a grenade.
For additional security, the zymogens are kept away from sensitive tissues in storage vesicles called zymogen granules, and are packaged