Pancreatitis (inflammatory disease of pancreas) Signs and Symptoms Diagnostic Tests

Pancreatitis (inflammatory disease of pancreas) Signs and Symptoms Diagnostic Tests

Pancreatic Diseases

Pancreatitis is inflammatory diseaseHypertension with Diabetes, heart failure, MI, CHF and Hypertension with Pregnancy. Read more ... » of pan­creas

Various presentations of Pancreatitis :

• · HypertriglyceridemiaDyslipidemias Causes Risk Factors Epidemiology Etiology. Read more ... »
• · Vitamin B₁₂ malsorption
• · HypercalcemiaPrimary Hypertension due to Endocrine adrenal Hypertension Adrenogenital syndrome Oral Contraceptives. Read more ... »
• · Hypocalcemia
• · HyperglycemiaDiabetes Insipidus (DI) Causes Diagnosis and Treatment. Read more ... »
• · Ascites
• · Pleural effusion
• · ChronicChronic Hepatitis Classification viral hepatitis Clinical features and Treatment. Read more ... » abdominal pain.

Pancreatitis Prognosis:

• Several techniques are used to determine how well (or how poorly) patients with pancreatitis will progress during their illness and whether they may benefit from intensive care.
• The best of these is the APACHE II systemHypertension with Diabetes, heart failure, MI, CHF and Hypertension with Pregnancy. Read more ... »; it grades patients with pancreatitis on the basis of 14 measurable physiological parameters, including the patient’s

Pancreatitis Classic presentation

• Pancreatitis Signs and Symptoms
• Pancreatitis History

• •Similar to an acuteHypertension with Diabetes, heart failure, MI, CHF and Hypertension with Pregnancy. Read more ... » abdomen of any cause
• •Acute pancreatitisACUTE PANCREATITIS Symptoms Diagnosis and Treatment. Read more ... »:
  • Alcohol use
  • Past history of gallstones
  • Family history of gallstones
  • Medication use
  • Abdominal trauma
  • Recent weight loss
• •Chronic pancreatitis:
  • Alcohol use
  • Signs of steatorrhea
  • Signs of hyperglycemia
• · Severe constant epigastric pain radiating to back.
• · Elevated serum amylase.

Pancreatitis Etiology

• · Unknown
• · Alcohol abuse
• · Biliary tract disease
•  Drugs
• · Trauma
• · Viral infections
• · Metabolic and connective tissue disorders.

Pancreatitis Diagnostic Tests and Interpretation–

Lab

• •No test is 100% sensitive or specific
• •Acute pancreatitis:
  • Elevated serum amylase (amylase P)
  • Elevated serum lipase
  • Liver function tests (LFTs): HyperbilirubinemiaHyperbilirubinemia Classification Types Symptoms Examination. Read more ... » and elevated (mild) ALT, AST, and/or alkaline phosphatase when associated with alcoholic hepatitis or choledocholithiasis
  • GlucoseGlycogen Storage Diseases von Gierke disease, Andersen's disease, McArdle's disease. Read more ... » increased in severe disease
  • Calcium decreased in severe disease
  • White blood cells (WBCs): 10,000–25,000/µL

Other Tests

• Serum Amylase: In patients with acute abdominal or back pain, estimation of serum amylase is done.
• If serum amylase is more than 65 units/litre, acute pancreatitis is a possibility.
• If serum amylase is more than 130 units per li­ter, the diagnosis is pancreatitis.
• In acute pancreatitis, serum amylase is increased from 24 hours to 3 days and returns to normal in 5 days.
• In acute pancreatitis, sometimes serum amylase may not be increased as in :
• 1. Late sample – after 5 days
• 2. In chronic pancreatitis
• 3. Hypertriglyceridemia.
• False elevation of serum amylase is seen in carcinoma lung, oesophagus, breast, ovary.
• Urinary amylase is not sensitive or specific. Elevation of pleural fluidPleural Effusion pleural fluid Causes Symptoms Diagnosis Treatment. Read more ... » and ascitic amylase occurs in other conditions also.
• Serum amylase more than 3 times normal is best test and highly specific for pancreatitis.
• Serum trypsinogen is elevated and is very specific for pancreas, but less sensitive.
• Normal is 28 to 58 ng/ml. Less than 20 ng/ml means> pancreatic steatorrhea.
• Trypsinogen levels are increased in pancreatitis as well as renalDiabetic Nephropathy and Renal complications of DM (Diabetes Mellitus). Read more ... » failure.
• Single best enzyme test for acute pancreatitis is li­pase estimation.

Tests for Pancreatic Structure X-ray: shows

• 1. Localized ileus in jejunum (sentinel loop)
• 2. Generalized ileus with air fluid levels
• 3. Colon cut-off sign (isolated distension of trans-
• verse colon)
• 4. Duodenal distension with air fluid levels
• 5. Massive pseudocyst
• 6. In chronic pancreatitis – pancreatic calcification on and around second lumbar vertebra.

Ultrasound: shows

• · Edema
• · Inflammation
• · Calcification
• · Pseudocyst
• · Mass lesions
• · Gall stones.
• In acute pancreatfti~ pancreas is enlarged. Pancreatic pseudocyst - echo-free smooth round fluid collection.
• In pancreatic carcinoma – distortion of normal struc­tures.
• If more than 3 cm localized echo-free solid lesion seen, it is usually carcinoma.
• In obesityACTH and TSH DEFICIENCY Diagnosis with Treatment. Read more ... » and gas in large bowel, pancreas difficult· to see.

CT is best for:

• · Chronic pancreatitis and complications.
• · Pancreatic tumors
• · Pancreatic pseudocyst
• · Abscess
• · Calcium deposition.
• Dynamic CT using rapid IV contrast is for pancreatic necrosis to predict mortality and morbidity.
• Spiral CT is very good.

Endoscopic ultrasonography (EUS)

•  is done to see pancreatic parenchyma and pancreatic duct, common bile duct stones, pseudo cyst.
• Endoscopic ultrasound (EUS) is better than Endoscopic retrograde cholepancreatography (ERCP).
• EUS is also for:
• Biopsy
• Nerve blocks through EUS Dilatation of main pancreatic duct.

Magnetic Resonance Cholepancreatography (MRCP)

• To see -
• Pancreatic duct Bile duct
• It is useful in elderly as it is a dure.
• Selective catheterization -
  • of celiac and superior mesenteric arteries, and hepatic, splenic, and gas­trgduodenal arteries for angiographyCoronary Angiography -Indications of Coronary Arteriography (Angiography). Read more ... ».
  • Percutaneous aspiration biopsy of pancreatic mass is done to differentiate between inflammatory swelli’ng and neoplasm.
• Exocrine pancreatic function
  • 1. Direct stimulation of pancreas by IV infusion of secretin, or secretin plus CCK (cholecystokinin), then measurement of duodenal contents.
  • 2. Study of digestion products from lumen like un­digested meat fibers, stool fat, fecal nitrogen.
  • 3. Measurement of pancreatic enzymes like elastase.