Chronic Pancreatitis, Pancreatic Insufficiency

Clinical manifestations: recurrent upper abdominal pain (pain ceases with
burned-out pancreatitis); pasty, fatty stools; weight loss, diabetes

Diagnosis:
>History: With a history of recurrent bouts of pancreatitis, try to elicit the precipitating cause. Many patients have a history of alcoholism, gallstones, drugs,
cystic fibrosis, malnutrition, or enzyme deficiency.
> Stool examination: collect stool for 3 days, weigh the samples. An average daily
weight i150g suggests pancreatic insufficiency

> Laboratory findings: glucose intolerance ranging to frank diabetes mellitus. Elevated cholesterol levels are common. Tests may include stool fat determination
(more than 7g of fat/day is abnormal).

Less common tests are chymotrypsin determination and/or pancreatic lactase in the stool. Vitamin deficiencies are common.
> Secretin-pancreozymin test is rarely necessary.
> Sonography
> Spot radiographs to check the pancreas for coarse calcifications
> ERCP

Sonographic findings 

> The pancreas may be normal in size, small, or even enlarged.
> Generally the parenchyma is somewhat nonhomogeneous with coarse, highlevel internal echoes (fibrosis, calcification).
> There may be irregular hypoechoic to anechoic areas indicating pseudocyst
formation.
> The surface of the organ may appear wavy and indistinct.
> There may be irregularity and slight dilatation of the pancreatic duct, with or
without calcification.
> Bowel wall thickening may be noted in the duodenal C loop.
> Incompressibility and “en bloc” movement of the fibrotic organ with aortic
pulsations.
Accuracy of sonographic diagnosis 

The detection of ductal dilatation, calcification, and pseudocysts confirms the
diagnosis, and this can be done sonographically in almost 85% of cases. If the
findings are equivocal, there is evidence that CT scans can provide a somewhat
higher diagnostic accuracy.
> FNAB can help in distinguishing a segmental pancreatitis or pancreatic cysts
from a pancreatic tumor, although the cytologic and histologic findings are
not always conclusive.
> With a sonographically confirmed tumor or indeterminate lesion that will or
may be treated operatively, percutaneous biopsy is contraindicated because
of the risk of seeding malignant cells along the needle track. A needle biopsy
may be done if guided by endosonography, however, because the needle tract
can subsequently be included in the resection.

Share :