Chronic pancreatitis diagnostic study of choice

Revision as of 19:58, 11 December 2017 by Iqra Qamar (talk | contribs) (→‎Overview)
Jump to navigation Jump to search

Chronic pancreatitis Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Chronic pancreatitis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

Diagnostic Study of Choice

Diagnostic Criteria

History and Symptoms

Physical Examination

Laboratory Findings

Abdominal X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

American Pancreatic Association Practice Guidelines

APA Clinical Practice Guidelines for Chronic pancreatiits

Chronic pancreatitis diagnostic study of choice On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Chronic pancreatitis diagnostic study of choice

All Images
X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Chronic pancreatitis diagnostic study of choice

CDC on Chronic pancreatitis diagnostic study of choice

Chronic pancreatitis diagnostic study of choice in the news

Blogs on Chronic pancreatitis diagnostic study of choice

Directions to Hospitals Treating Chronic pancreatitis

Risk calculators and risk factors for Chronic pancreatitis diagnostic study of choice

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

The diagnostic study of choice for chronic pancreatitis is magnetic resonance cholangiopancreatography (MRCP). The diagnosis is difficult to establish as the laboratory results and the imaging may be normal. Diagnostic findings confirmatory for chronic pancreatitis may include pancreatic calcifications seen on abdominal plain films or CT scan, beaded appearance of main pancreatic duct seen on pancreatogram, abnormal pancreatogram showing ectatic side branches from the main pancreatic duct and abnormal pancreatic function tests (Secretin test).

Diagnostic Study of Choice

Gold standard/Study of choice:

  • The diagnostic study of choice for chronic pancreatitis is magnetic resonance cholangiopancreatography (MRCP) because
    • It may help in the detailed assessment of the ductal changes.
    • It eliminates the need to perform endoscopic retrograde cholangiopancreatography (ERCP).

Diagnostic Criteria

  • The diagnosis is difficult to establish as the laboratory results and the imaging may be normal.
Diagnostic findings suggestive of Chronic pancreatitis:

Diagnostic findings suggestive of Chronic pancreatitis include the triad of:

  • Pancreatic calcifications
  • Steatorrhea
  • Diabetes mellitus
Diagnostic findings confirmatory for Chronic pancreatitis:

Diagnostic findings confirmatory for chronic pancreatitis may include

  • Pancreatic calcifications seen on abdominal plain films or CT scan
  • Beaded appearance of main pancreatic duct seen on pancreatogram
  • Abnormal pancreatogram showing ectatic side branches from the main pancreatic duct
  • Abnormal pancreatic function tests (Secretin test)

M-ANNHEIM diagnostic criteria of chronic pancreatitis

  • The diagnosis usually requires a typical history of chronic pancreatitis (recurrent pancreatitis or abdominal pain).
  • The diagnosis for the various forms of chronic pancreatitis can be established by the following features.
Form of chronic pancreatitis Diagnostic criteria
Definite chronic pancreatitis Established by one or more of the following additional criteria:
  • Pancreatic calcifications
  • Moderate or marked ductal lesions (according to the Cambridge classification)
  • Marked and persistent exocrine insufficiency defined as pancreatic steatorrhea markedly reduced by enzyme supplementation
  • Typical histology of an adequate histological specimen
Probable chronic pancreatitis Established by one or more of the following additional criteria:
  • Mild ductal alterations (according to the Cambridge classification)
  • Recurrent or persistent pseudocysts
  • Pathological test of pancreatic exocrine function (such as fecal elastase-1 test, secretin test, secretin–pancreozymin test)
  • Endocrine insufficiency (i.e., abnormal glucose tolerance test)
Borderline chronic pancreatitis Established as a first episode of acute pancreatitis with or without:
  • A family history of pancreatic disease (i.e., other family members with acute pancreatitis or pancreatic cancer)
  • The presence of M-ANNHEIM risk factors
Pancreatitis associated with alcohol consumption Requires in addition to the above-mentioned criteria for definite, probable, or borderline chronic pancreatitis one of the following features:
  • History of excessive alcohol intake (>80 g/day for some years in men, smaller amounts in women) or
  • History of increased alcohol intake (20–80 g/day for some years) or
  • History of moderate alcohol intake (<20 g/day for some years)
M-ANNHEIM pancreatic imaging criteria for US, CT, MRI/MRCP, and EUS based on imaging features as defined by the Cambridge classification
Cambridge grading CT, US, MRI/MRCP EUS
Normal Quality study depicting whole gland without abnormal features
Equivocal One abnormal feature Four or fewer abnormal features (no differentiation between equivocal and mild)
Mild changes Two or more abnormal features, but normal main pancreatic duct
Moderate changes Two or more abnormal features, including minor main Five or more abnormal features pancreatic duct abnormalities (either enlargement between 2 and 4 mm or increased echogenicity of the duct wall) Five or more abnormal features (no differentiation between moderate and marked)
Marked changes As above with one or more of the required features of marked changes

References


Template:WikiDoc Sources