Chronic pancreatitis: A diagnostic dilemma

Figure 1 Computed tomography demonstrating enlarged head of pancreas with coarse calcification and a dilated main pancreatic duct (A), magnetic resonance cholangiopancreatography showing a tortuous, dilated pancreatic duct (B), inflammatory stricture of the distal common bile duct (C), endoscopic retrograde cholangiopancreatography showing a stent placed in a dilated pancreatic duct (D).

Figure 2 Step-wise algorithm approach to diagnosis of chronic pancreatitis. Step 1: Survey (data review, risk factors, CT-imaging); Step 2: Tomography (pancreas protocol CT scan, MRI/secretin-enhanced magnetic resonance cholangiopancreatography); Step 3: Endocopy [EUS (standard criteria)]; Step 4: Pancreas functioning (Dreiling, ePFT); Step 5: ERCP (with intent for therapeutic intervention). From Conwell et al[2]. CT: Computed tomography; MRI: Magnetic resonance imaging; EUS: Endoscopic ultrasound; ERCP: Endoscopic retrograde cholangiopancreatography.

Figure 3 Relation of lipase outputs per 24 h to fecal fat excretion in healthy subjects and patients with chronic pancreatitis. Values above the horizontal dashed line denote steatorrhea (> 7 g per 24 h). The shaded area represents lipase outputs less than 10 percent of normal. From DiMagno et al[34]. Copyright © 2015 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.

Figure 4 Relation of lipase output to fecal fat excretion in 47 patients with exocrine insufficiency. Reprinted with permission from Lankisch et al[35]. Copyright © 2015 Karger Publishers, Basel, Switzerland.