Diagnosis Of Chronic Pancreatitis: Function Test And Imaging

Diagnosis Of Chronic Pancreatitis: Function Test And Imaging . Mild forms of chronic pancreatitis is difficult to diagnose, hence a combination of tests are required. Estimation of serum amylase and lipase as in acute pancreatitis is usually not helpful in this case.

Chronic Pancreatic Function Test

• Secretin- pancreozymin test is the gold standard test for chronic pancreatitis.
  • It involves estimation of volume, bicarbonate and enzyme secretion in duodenal aspirate after injection of secretin and pancreozymes.
  • In chronic pancreatitis all these parameters will be reduced.
• Tubeless pancreatitis function test.
  • This includes the NBT-PABA test and pancreolauryl test.
  • These are good screening tests for advanced form of disease.

Diagnostic Tests For Chronic Pancreatitis

Mainstay of diagnosis is imaging studies.

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• X-ray abdomen – Demonstration of pancreatic calculi on plain X-ray of abdomen is conclusive of chronic pancreatitis. Calculi are demonstrable in about 30% alcoholic and 60 to 90% of cases of tropical pancreatitis.
• USG – It demonstrates ductal dilation, parenchymal changes like enlargement or atrophy, presence of pseudo cyst and tumor.
• CT-scan – It is more sensitive in demonstrating calculi and small mass lesions missed by USG. Role of MRI in chronic pancreatitis is yet not established.
• ERCP – It is helpful in planning surgery by delineating the ductal morphology. Ductal changes like stricture dilatation and block are demonstrated.
  
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Segmental dilatation of main pancreatic duct gives rise to classical “chain of lakes” appearance.

Intra-ductal calculi and communicating cysts are well delineated.

Presence of a mass lesion on USG and CT-scan with ductal block on ERCP is suggestive of pancreatic cancer.

ERCP is also helpful in delineating biliary obstruction and for therapeutic interventions.

• Endoscopy – USG is a new imaging modality giving close details of the morphological changes and is especially helpful in pre-operative assessments of cysts and tumor.
• C. Estimation of tumor markers like CA-19-9 and carcinoembryogenic antigen (CEA) is done when malignancy is suspected, but their sensitivity and specificity are not high.