Chronic pancreatitis diagnostic study of choice

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