A patient with a long history of alcohol use has recurrent epigastric pain, weight loss with greasy offensive stools, and is now diabetic. Abdominal X-ray shows pancreatic calcification. What is the diagnosis?

Answer: C. Chronic pancreatitis

Chronic pancreatitis

Recurrent epigastric pain, weight loss with steatorrhoea (greasy, offensive stools), diabetes, and pancreatic calcification form the classic picture of chronic pancreatitis (most commonly alcohol-related).

The classic triad

1. Abdominal pain.
2. Exocrine deficiency - weight loss and steatorrhoea (fat malabsorption).
3. Endocrine deficiency - diabetes (loss of islet function).

Aetiology

• Alcohol (commonest), tropical (calcific), idiopathic, hereditary, obstructive, autoimmune; pancreatic duct stricture.

Investigation

• Serum amylase is usually normal or only mildly elevated (unlike acute pancreatitis).
• Imaging shows calcification, a dilated pancreatic duct, and complications (ultrasound, CT, MRCP).

Treatment

• Pain relief, enzyme supplementation (pancreatin) for exocrine failure, and insulin for diabetes.