ESSENTIALS OF DIAGNOSIS
Diagnosis relies on a combination of clinical findings, imaging tests, and pancreatic function testing.
Pancreatic calcifications, dilated pancreatic ducts, diabetes mellitus, and maldigestion characterize advanced disease.
Early-stage diagnosis remains a clinical challenge, especially in patients with chronic or episodic abdominal pain and no imaging abnormalities.
Although several risk factors for the development of chronic pancreatitis have been identified, the cause of pancreatitis in some instances remains uncertain. Among established risk factors, alcohol ingestion is associated with up to 60–70% of cases of chronic pancreatitis. In addition, ductal obstruction, autoimmune disease, tropical disease, and an association with further systemic illnesses such as scleroderma and hypertriglyceridemia have been described. Recently new insights have been gained into the genetic and molecular basis associated with hereditary forms of chronic pancreatitis. Recent epidemiologic studies clearly demonstrate that smoking is emerging as an independent risk factor for chronic pancreatitis development. The most widely accepted system of etiologic classification for chronic pancreatitis is the TIGAR-O system, which categorizes risk factors according to mechanism and prevalence (Table 27–1). A more recent M-ANNHEIM multiple risk factor classification system incorporates etiology, different stages of the disease, and various degrees of clinical severity. This system will be helpful for research studies investigating the impact and interaction of various risk factors on the course of the disease and will facilitate the comparison and combination of interinstitutional data.
Table 27–1.TIGAR-O classification of chronic pancreatitis. |Favorite Table|Download (.pdf) Table 27–1. TIGAR-O classification of chronic pancreatitis.
Recurrent and Severe Acute Pancreatitis
Pancreas divisum (controversial)
Sphincter of Oddi dysfunction (controversial)
Duct obstruction (tumors, post-traumatic)
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