Pain occurs in most patients at advance stage of the disease. This may vary in intensity from mild to severe. It may last for hours or sometimes days at a time and sometime strong painkillers also gets no effect. It often radiates through to the back and can sometimes be relieved by crouching forward. It is commonly brought on by food consumption and so patients may be afraid to eat. It is also commonly severe through the night. The pain varies in nature, being gnawing, stabbing, aching or burning, but it tends to be constant when at late stage and may comes and go in waves. It may sometimes burn itself out but can remain an ongoing problem.
The mechanism of the pain is the obstruction of Qi in the organ. Some patients will have obstruction to the small ducts in the pancreas by small stones, and this is thought to cause back pressure and destruction of the pancreas. There is no relationship between the severity of the pain and the severity of the pancreatic inflammation.
The pain is often difficult to diagnose and can be mistaken for pain caused by virtually any other condition arising from the abdomen or lower chest.
The pain caused by pancreatitis may be a little same to pain caused by a peptic ulcer, irritable bowel syndrome, angina pectoris, gallstones.
Diabetes is also a common symptom which affects over half of all patients with long-standing chronic pancreatitis. Long-standing chronic inflammation results in scarring of the pancreas which destroys the specialise areas of the pancreas which produce insulin. Deficiency of insulin results in diabetes. Diabetes causes thirst, frequent urination and weight loss.
Diarrhoea occurs in just under half of patients. Normally, all the fat in food is broken down by enzymes from the pancreas and small intestine, and the fat is then absorbed in the small bowel. With a reduced level of digestive enzymes the fat is not absorbed. When the fat reaches the large intestine, it is partially broken down by the bacteria in the colon. This produces substances which irritate the colon and result in diarrhoea. The undigested fat also traps water in the faeces, resulting in pale, bulky, greasy stools which are difficult to flush away. They may make the water in the toilet look oily, smell offensive and may be associated with wind.
Weight loss occurs in virtually all patients with chronic pancreatitis. It is due to failure to absorb calories from food, and diabetes may also contribute to this. In addition, patients may be afraid to eat because eating brings on the pain. Depression is also common in chronic pancreatitis and this can also reduce appetite and lead to weight loss.
Jaundice (when patients develop yellow eyes and skin) occurs in about a third of patients with chronic pancreatitis. It is usually due to damage to the common bile duct which drains bile from the liver to the duodenum. The common bile duct normally passes though the head of the pancreas. In long-standing chronic pancreatitis, the scarring in the head of the pancreas narrows the common bile duct. Some degree of narrowing may occur in up to half the patients with chronic pancreatitis but when the narrowing is severe, it prevents the bile draining from the liver into the duodenum. It then spills back into the blood and the patient's eyes and skin become yellow.
Vomiting after meals is a less common symptom but can occur as a result of severe pain. It may also be due to duodenal ulceration, which is often connected with chronic pancreatitis. In rare cases, the duodenum may be narrowed as a result of scarring secondary to chronic pancreatitis.
The patient will also feels very tired and dizzy from the pain and the episode. Some of them may not be able to stand up.