Chronic Pancreatitis: Making the Diagnosis

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Presentation transcript:

Chronic Pancreatitis: Making the Diagnosis Darwin L. Conwell, Bechien U. Wu Clinical Gastroenterology and Hepatology Volume 10, Issue 10, Pages 1088-1095 (October 2012) DOI: 10.1016/j.cgh.2012.05.015 Copyright © 2012 AGA Institute Terms and Conditions

Figure 1 STEP-wise algorithm for the diagnosis of chronic pancreatitis. Clinical Gastroenterology and Hepatology 2012 10, 1088-1095DOI: (10.1016/j.cgh.2012.05.015) Copyright © 2012 AGA Institute Terms and Conditions

Figure 2 CT chronic pancreatitis (Cambridge, marked changes). (A) Pancreatic calcifications (black arrow); marked pancreatic ductal dilation (10 mm) and glandular atrophy (white arrow). (B) Diffuse pancreatic calcifications in head, neck, and body of pancreas (black arrows, coronal view). Clinical Gastroenterology and Hepatology 2012 10, 1088-1095DOI: (10.1016/j.cgh.2012.05.015) Copyright © 2012 AGA Institute Terms and Conditions

Figure 3 sMRCP chronic pancreatitis (Cambridge, marked changes). Diffuse dilatation of the pancreatic duct and multiple side branches, consistent with chronic pancreatitis. (A) Dilatation of the main pancreatic duct in the body and tail (white arrow). Pseudocysts are identified in the tail of the pancreas (black arrows). (B) Dilated main duct with areas of absent signal likely represents calcification and debris (white arrows). Abnormal pancreatic duct side branches (dashed white arrows). There was no significant change in the caliber of the main pancreatic duct after the administration of secretin, suggesting scarring and fibrosis of the duct. Pancreas fluid is seen in the small bowel after secretin stimulation. Clinical Gastroenterology and Hepatology 2012 10, 1088-1095DOI: (10.1016/j.cgh.2012.05.015) Copyright © 2012 AGA Institute Terms and Conditions

Figure 4 Commonly described EUS chronic pancreatitis criteria. (A) Hyperechoic strands. (B) Hyperechoic duct wall. (C) Parenchymal calcifications. (D) Irregular hyperechoic duct. (E) Pancreatic duct stone. Clinical Gastroenterology and Hepatology 2012 10, 1088-1095DOI: (10.1016/j.cgh.2012.05.015) Copyright © 2012 AGA Institute Terms and Conditions

Figure 5 Direct pancreas function test. Endoscopic view of the duodenum after cholecystokinin (A) or secretin (B) stimulation of the pancreas. Clinical Gastroenterology and Hepatology 2012 10, 1088-1095DOI: (10.1016/j.cgh.2012.05.015) Copyright © 2012 AGA Institute Terms and Conditions