Chronic pancreatitis diagnostic study of choice: Difference between revisions

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VisualWikitext

Latest revision as of 20:56, 2 February 2018

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 because 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 shows ectatic side branches from the main pancreatic duct and abnormal pancreatic function tests (Secretin stimulation test).

Diagnostic Study of Choice

Gold standard or 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:

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)

References

Template:WikiDoc Sources

@@ Line 4: / Line 4: @@
 == Overview ==
-The diagnostic study of choice for chronic pancreatitis is [[Magnetic resonance cholangiopancreatography|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 [[Calcification|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).
+The diagnostic study of choice for chronic pancreatitis is [[Magnetic resonance cholangiopancreatography|magnetic resonance cholangiopancreatography (MRCP)]]. The [[diagnosis]] is difficult to establish because the laboratory results and the imaging may be normal. Diagnostic findings confirmatory for chronic pancreatitis may include [[pancreatic]] [[Calcification|calcifications]] seen on abdominal plain films or [[CT scan]], beaded appearance of main [[pancreatic duct]] seen on pancreatogram. Abnormal pancreatogram shows ectatic side branches from the main [[pancreatic duct]] and abnormal pancreatic function tests ([[Secretin]] stimulation test).
 == Diagnostic Study of Choice ==
-=== Gold standard/Study of choice: ===
+=== Gold standard or study of choice: ===
-*The diagnostic study of choice for chronic pancreatitis is [[Magnetic resonance cholangiopancreatography|magnetic resonance cholangiopancreatography (MRCP)]] because
+*The diagnostic study of choice for chronic pancreatitis is [[Magnetic resonance cholangiopancreatography|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|endoscopic retrograde cholangiopancreatography (ERCP)]].
@@ Line 16: / Line 16: @@
 *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: =====
 Diagnostic findings suggestive of chronic pancreatitis include the triad of:
 * [[Pancreatic]] [[Calcification|calcifications]]
@@ Line 28: / Line 28: @@
 * 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.
-{| class="wikitable"
-!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 =====
-{| class="wikitable"
-!Cambridge grading
-!CT, US, MRI/MRCP
-!EUS
-|-
-|Normal
-|Quality study depicting whole gland without abnormal features
-|
-|-
-|Equivocal
-|One abnormal feature
-| rowspan="2" |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)
-| rowspan="2" |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==