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Chronic Pancreatitis

Chronic Pancreatitis

Chronic Pancreatitis Symptoms

The main symptom of chronic pancreatitis is abdominal pain. The pain can be sudden and severe or you may experience more mild episodes of pain. For some patients, the pain is constant.

Other symptoms include:

Chronic Pancreatitis Diagnosis at Johns Hopkins

Chronic pancreatitis can be difficult to diagnose. Your family and medical history are important in helping your doctor diagnose this disease. At Johns Hopkins, our experienced gastroenterologists combine their expertise and training with advanced imaging technology to arrive at an accurate diagnosis.

Chronic Pancreatitis Diagnostic Procedures

Your doctor will begin the diagnosis with a comprehensive physical exam. We will also ask you about your symptoms and medical history.

Diagnostic tests your doctor may order include:

Laboratory Testing

Your doctor may use a combination of different laboratory tests to help diagnose chronic pancreatitis. We may examine your blood, urine and stool, looking for abnormalities or unusual levels of certain enzymes.
Lab tests include:

  • Fecal fat test measures the amount of fat in the stool, indicating your body is not absorbing all of the fat.

  • Amylase test is a blood test measuring the amount of amylase, an enzyme that helps digest carbohydrates. Pancreas inflammation causes amylase to be released into the blood.

  • Lipase test measures the amount of lipase in your blood. Lipase helps the body absorb fat and is released by the pancreas.

  • Trypsinogen test measures the amount of trypsinogen in your blood. This substance helps break down proteins.

  • Bentiromide test i s a urine test that can diagnose advanced chronic pancreatitis.

Imaging Scans

Your doctor may order one or more of the following imaging scans. The goal is to get a clear, detailed picture of your pancreas so your doctor can examine any abnormalities.

  • X-ray images are often the first step in diagnosing chronic pancreatitis. Your doctor can examine the images for signs of disease on the pancreas.

  • Ultrasound uses sound wave technology to create images. This is helpful in detecting changes to the pancreatic ducts or the presence of calcium deposits.

  • Computed tomography (CT) is a powerful X-ray and is more sensitive than an ultrasound. It is also helpful in distinguishing pancreatitis from pancreatic cancer.

  • Magnetic resonance cholangiopancreatography (MRCP) is a specialized magnetic resonance imaging (MRI) scan, used specifically to examine the pancreatic area. If a CT scan was normal, your doctor may recommend MRCP, which allows the doctor to view the area in even more detail.

Upper Endoscopy

During an upper endoscopy, your doctor threads a thin, flexible tube down your throat, past your esophagus and into your stomach and small intestine. The endoscope sends images of your internal organs to your doctor. Upper endoscopy provides your doctor with enhanced visualization of the upper gastrointestinal tract. Upper endoscopy also allows us to biopsy the digestive tract to help confirm a diagnosis.

During an upper endoscopy:

  1. You receive an anesthetic to relax your gag reflex . You may also receive pain medication and a sedative.

  2. You lie on your left side, referred to as the left lateral position.

  3. Your doctor inserts the endoscope through your mouth and pharynx, into the esophagus.

  4. The endoscope transmits images of the upper gastrointestinal tract.

  5. Your physician inserts biopsy forceps into the endoscope to obtain tissue samples. We send the samples to a laboratory for a definitive diagnosis.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP is an endoscopic technique that allows your doctor to visualize the bile and pancreatic ducts. During this procedure, your doctor uses a special side-viewing endoscope, inserting it into the duodenum. This endoscope, called a duodenoscope, is specially designed so your doctor can easily place endoscopic accessories into the bile and pancreatic ducts. Your doctor will also inject a dye into the ducts to obtain detailed X-ray images.
ERCP is a sensitive and specific test for diagnosing chronic pancreatitis.

Endoscopic Ultrasound (EUS)

EUS combines an endoscopy with an ultrasound to obtain images from your gastrointestinal tract. The procedure is similar to an upper endoscopy. Your doctor may recommend EUS to rule out cancer.

Chronic Pancreatitis Treatment at Johns Hopkins

The goal of chronic pancreatitis treatment is to manage the disease and support the patient. We will aim to control your pain and repair damage caused by complications. Learn more about chronic pancreatitis treatment at Johns Hopkins.

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