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Bаsed оn yоur knоwledge of the diаgnosis of different cаuses of abdominal obstruction match the cause of the obstruction with the diagnostic test or lab finding best used to diagnose the specific cause of obstruction.

Chrоnic Pаncreаtitis 1. Bаckgrоund Definitiоn: Progressive, irreversible inflammation and fibrosis of the pancreas leading to permanent loss of exocrine and endocrine function. Pathophysiology: Repeated episodes of acute inflammation cause destruction of acinar cells, ductal obstruction, and fibrosis. Loss of enzyme-producing tissue → malabsorption and steatorrhea. Islet cell destruction → diabetes mellitus (pancreatogenic, Type 3c). Epidemiology: More common in middle-aged men and those with chronic alcohol use. Develops after years of recurrent injury. 2. Etiology and Risk Factors Alcohol use (most common, ~70%) — chronic toxicity causes ductal protein plugs and inflammation. Recurrent acute pancreatitis from gallstones, hypertriglyceridemia, or medications. Genetic: CFTR, PRSS1, SPINK1 mutations (younger onset). Autoimmune pancreatitis: IgG4-mediated; may cause pancreatic enlargement and strictures. Obstructive: Tumor, stricture, or pancreatic divisum. Idiopathic: Up to 10% of cases. 3. History Symptoms: Chronic epigastric pain radiating to the back; often postprandial, persistent, or episodic. Pain may lessen in late stages when pancreas becomes fibrotic (“burned-out pancreas”). Steatorrhea (bulky, foul, oily stools) and weight loss due to fat malabsorption. Diabetes in advanced disease. History clues: Long history of alcohol use or recurrent acute pancreatitis. May report reduced appetite and fear of eating due to pain. 4. Exam Findings General: Cachexia, dehydration, muscle wasting. Abdomen: Epigastric tenderness or fullness, mild distension. Complications: Jaundice (from bile duct compression). Palpable mass (pseudocyst). Signs of malnutrition or diabetes. 5. Making the Diagnosis A. Laboratory Findings Amylase and lipase often normal or mildly elevated (unlike acute pancreatitis). Fecal elastase 7 g/day) indicates steatorrhea. Fasting glucose/A1c: Detects diabetes from islet cell loss. B. Imaging Test Findings / Role CT abdomen (initial test) Pancreatic calcifications, ductal dilation, atrophy. MRCP / EUS Detect ductal changes, stones, or strictures with higher sensitivity. ERCP (diagnostic & therapeutic) “Chain of lakes” ductal pattern (rarely used purely diagnostically due to risk). C. Distinguishing Features Condition Key Features Acute pancreatitis Elevated lipase, reversible inflammation Chronic pancreatitis Normal enzymes, irreversible fibrosis, calcifications, malabsorption 6. Management A. Lifestyle and Supportive Care Absolute alcohol abstinence and smoking cessation (both accelerate progression). Small, low-fat meals; avoid large, fatty, or fried foods. Pain control: Stepwise approach (NSAIDs → opioids → nerve block if refractory). B. Pancreatic Enzyme Replacement Pancrelipase with meals and snacks → improves digestion and reduces steatorrhea. Add PPI or H2 blocker to improve enzyme efficacy by reducing gastric acid inactivation. C. Nutritional Support Supplement fat-soluble vitamins (A, D, E, K) and calcium. Manage malnutrition and osteoporosis risk. D. Glycemic Control Insulin therapy for diabetes secondary to pancreatic failure. E. Endoscopic / Surgical Options ERCP with stent or stone removal for ductal obstruction. Celiac plexus block for severe pain. Surgical decompression or resection in refractory cases (e.g., Puestow procedure). F. Complications Local Systemic Pseudocyst, bile duct obstruction, pancreatic cancer Malabsorption, diabetes, osteoporosis Question A 52-year-old man presents with chronic upper abdominal pain and weight loss. He reports that his pain is dull, located in the epigastrium, and radiates to the back. The pain worsens after meals and is partially relieved when he leans forward. He has had several prior hospitalizations for “pancreatic attacks.” His stools are bulky, greasy, and difficult to flush. He drinks six to eight beers daily. Which of the following findings is most consistent with the underlying condition?