Chronic pancreatitis is a long-term, progressive inflammatory disease that causes irreversible damage to the pancreas. This leads to a gradual decline in the organ’s ability to produce digestive enzymes and hormones. Unlike acute pancreatitis, which is a sudden inflammation, chronic pancreatitis is a persistent and often debilitating illness. Diagnosing this condition is a multifaceted process, frequently requiring a combination of various medical assessments.
Initial Evaluation of Symptoms and Medical History
Diagnosis often begins with a thorough discussion between the patient and their healthcare provider. Doctors inquire about classic symptoms that may indicate pancreatic dysfunction. These commonly include persistent or recurring upper abdominal pain, which might radiate to the back and often worsens after eating. Patients may also report unexplained weight loss, occurring even without changes in diet, and steatorrhea, characterized by oily, foul-smelling stools that are difficult to flush, indicating impaired fat digestion.
A detailed medical and family history is also important. The doctor will ask about alcohol consumption patterns, as excessive alcohol intake is a significant risk factor. Questions about smoking habits are also pertinent, given their association with pancreatic damage. A family history of pancreatitis or pancreatic disorders can offer important clues. The healthcare provider will also inquire about any previous episodes of acute pancreatitis, as repeated attacks can progress to the chronic form of the disease.
Laboratory and Blood Testing
After the initial symptom review, laboratory and blood tests are often ordered to assess pancreatic function and overall health. Pancreatic enzyme tests, specifically for amylase and lipase, are commonly performed. While these enzymes are elevated during acute pancreatitis, in chronic cases, their levels may be normal or only slightly elevated due to the progressive destruction of enzyme-producing cells.
Other relevant blood tests assess the broader impact of chronic pancreatitis. Tests for vitamin deficiencies, such as fat-soluble vitamins A, D, E, and K, may be conducted, as impaired fat digestion can lead to malabsorption. High blood sugar levels, indicating the development of diabetes, are also monitored, as the pancreas produces insulin. Liver function tests are performed to help rule out other conditions with similar symptoms.
Diagnostic Imaging Studies
Non-invasive imaging studies play a role in visualizing the pancreas and identifying structural changes characteristic of chronic pancreatitis. A Computed Tomography (CT) scan is frequently used as a primary tool to detect classic signs. This method can reveal pancreatic calcifications (hardened deposits within the gland) and atrophy (shrinkage of pancreatic tissue). CT scans can also show dilation of the pancreatic duct, a common finding where the main duct becomes widened.
Magnetic Resonance Imaging (MRI) provides more detailed images of soft tissues compared to CT scans. Magnetic Resonance Cholangiopancreatography (MRCP) is a specialized MRI that focuses on detailed pictures of the pancreatic and bile ducts. This technique allows doctors to assess the ductal system for abnormalities like strictures or stones without requiring an endoscopic procedure. An abdominal ultrasound may also be used as an initial, less invasive screening tool, though it often provides less detailed images of the pancreas compared to CT or MRI due to gas in the bowels.
Advanced Endoscopic and Function Tests
When initial evaluations and standard imaging studies do not provide a definitive diagnosis, more advanced endoscopic and functional tests may be employed. Endoscopic Ultrasound (EUS) uses a thin, flexible tube with an ultrasound probe guided through the mouth into the stomach and small intestine. This proximity allows EUS to provide detailed images of the pancreas, detecting subtle changes like small calcifications or ductal irregularities that might be missed by CT or MRI. During EUS, a biopsy can also be performed, where a small tissue sample is collected for microscopic examination to confirm the diagnosis or rule out other conditions.
Pancreatic function tests measure the pancreas’s exocrine function, which involves producing digestive enzymes. One such test is the secretin stimulation test. In this procedure, the hormone secretin is administered intravenously, stimulating the pancreas to release bicarbonate and digestive enzymes. Fluid from the duodenum (the first part of the small intestine) is then collected via an endoscope, and the output of bicarbonate and enzymes is measured. Reduced levels after stimulation indicate impaired pancreatic function.