Internal Medicine

0521779407-C02 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:53

344 Chronic Pancreatitis

➣serum amylase and lipase are often only slightly elevated or nor-

mal.

➣glucose levels may be abnormal secondary to diabetes

■Radiology

➣plain abdominal films – calcifications

➣ultrasound

➣CT scan: 75–90% sensitive

■Endoscopy

➣ERCP currently the gold standard

■Pancreatic function tests

➣secretin stimulation test – it requires the collection of duodenal

juice secreted after secretin administration followed by the mea-

surement of bicarbonate and protein secreted. Rarely available

to most practioners.

➣“tubeless” test is useful for severe disease

bentiromide test (BT-PABA)

serum trypsin-like immunoreactivity

differential diagnosis

■other common causes of abdominal pain such as biliary tract disease,

peptic ulcer disease, and intestinal ischemia.

■pancreatic cancer

■cholangiocarcinoma

management

What to Do First

■Pain – represents the most common management problem

➣first exclude correctable causes of pain

pseudocyst

biliary stricture

duodenal stenosis

peptic ulcer disease

pancreatic cancer

specific therapy

■trial of high-dose pancreatic enzymes along with acid supression

(e.g. H 2 -antagonist)

■analgesics

■consider therapeutic endoscopy (e.g. sphincterotomy, lithotripsy,

pancreatic duct stenting

➣controversial and should be performed in an investigational set-

ting