At chronic pancreatitis of pain are often localized in left hypochondrium — with irradiation in the left half of a thorax or a shovel; pains can be also localized in right hypochondrium, and sometimes have the surrounding character. It is considered that at defeat of a head of a pancreas of pain are localized in the right upper half of a stomach; at preferential damage of a body of a pancreas — in epigastric area; at damage of a tail of a pancreas — in left hypochondrium; at diffusion damage of a pancreas girdle pains are observed. Usually pains are followed by dryness in a mouth, nausea, an eructation, the vomiting which is not giving relief, sometimes — ponosam. Developing of pains is provoked by reception plentiful write, especially fat and acute, a large number of crude vegetables and a citrus, and also alcohol intake, a psychoemotional stress, a hard physical activity, overcooling. Usually pains amplify at the end of meal or in 30 — 60 min. after food therefore patients with the purpose to warn pain sometimes reduce quantity of food or even starve. Pains can proceed many hours, often amplify in the second half of day, and also at night. Eventually expressiveness of pains decreases, and hyposecretory manifestations accrue.
Signs of pancreatic exocrine insufficiency
In 5 — 10 against a pain syndrome the exogenous insufficiency of a pancreas which is shown in the form of polyexcrements (to 1 and more than a kg a day), tendency to an unstable chair develops (2 — 5 and more times a day). The chair is plentiful kashitseobrazny, "fat" character (badly washes off) that is connected with insufficiency of a lipase, the steatorrhea is expressed. At patients nausea, weight loss is observed. First of all there is an insufficiency of a lipase that leads to disturbance of absorption of fats, fat-soluble vitamins (A, D, E and K) that sometimes is followed by damage of bones and disturbance of a blood coagulation. The steatorrhea arises at decrease in pancreatic secretion by 10% and more.
Signs of pancreatic endocrine insufficiency
In far come cases at patients symptoms of endocrine insufficiency can be shown: disturbance of tolerance to carbohydrates and even development of a diabetes mellitus. The diabetes mellitus at patients with chronic pancreatitis is characterized by high sensitivity to insulin drugs (tendency to a hypoglycemia), respectively — need for small doses of insulin, rare development of ketoacidosis and vascular complications.