A 44-year-old male patient with a heavy alcohol-abuse history (12 drinks per day), a 4-year history of abdominal pain, and steatorrhea presented to the clinic. 

His labs, including amylase and lipase, were normal. Computed tomography (CT) scan and colonoscopy were negative for significant findings. 

I started treatment with pancrelipase for presumed pancreatitis. The pain decreased and the stool turned normal. Would this be a case of acute pancreatitis or of chronic pancreatitis? 

Continue Reading

And given no obvious CT findings, how long should I continue the treatment with pancrelipase?
 — T. Alexandria Snyder, A/GNP, Dublin, Ga.

With the steatorrhea I’d worry about pancreatic insufficiency as well as pancreatitis. So off of pancreatic replacements, or even on them, check a fecal elastase to see if the patient is still deficient. 

The fact that the pain improved leads me to believe that it could have been acute pancreatitis, given his history.Sharon Dudley-Brown, PhD, FNP-BC, co-director, gastroenterology and hepatology, Nurse Practitioner Fellowship Program, Johns Hopkins University Schools of Medicine & Nursing, Baltimore (191-4)

These are letters from practitioners around the country who want to share their clinical problems and successes, observations and pearls with their colleagues. We invite you to participate. If you have a clinical question, submit it here.