Differential diagnosis of chronic pancreatitis

To determine chronic pancreatitis should promptly see a doctor and undergo the necessary tests.

It is very important that a qualitative differential diagnosis of chronic pancreatitis with such diseases as:

• ulcer of the stomach, duodenum;
• with pancreatic tumors;
• with chronic colitis;
• by abdominal ischemic syndrome;
• by intestinal tuberculosis;
• is a cholelithiasis.

Complaints of a patient

During an exacerbation, patients complain of pain in the left hypochondrium or areas of the stomach that give to the chest, a scapula on the left, they can be shingles, blunt noises or sharp ones. Their appearance is associated with eating. In addition to pain, complaints can be on vomiting, diarrhea, containing an admixture of not digested food, flatulence or rapid weight loss.

Even during remission, patients often complain of dull pain, nausea, a stool abundant in mushy, grayish color. Sometimes the patient's complaints can be on the appearance of allergies and symptoms of intoxication: weakness of dizziness and headache.

Symptoms

Pain syndrome - characterized by the appearance of pain in the left hypochondrium with irradiation into the chest on the left or in the epigastric region, less often in the left scapula, arm, behind the sternum or heart region. The pain intensifies in the case of non-compliance with the diet and eating contraindicated foods: fried, peppery, fatty and others.

Dyspeptic syndrome - flatulence, nausea, vomiting, belching.

Symptoms of exocrine insufficiency :

• stool is plentiful, with a specific smell, gray in the form of gruel and with a fat gloss up to 3 times a day;
• patient notes rapid weight loss;
• manifestations of hypovitaminosis developing with a lack of vitamins A, D, E, K.

Signs of endocrine insufficiency :

• at an early stage appear signs of hyperinsulinism - hypoglycemia, which is characterized by weakness, cold sweat,, Trembling in the body and limbs;
• for the later stages are characterized by signs of pancreatogenic diabetes mellitus.

During the examination of the patients, the following signs of can be identified:

• tongue coated with white coating;
• signs of hypovitaminosis: brittle hair, nails, "seizures" in the corners of the mouth, dry skin and peeling;
• on the skin of the back, stomach and chest with pressure appear red spots that disappear after a while;
• for palpation of the abdomen - characterized by the appearance of pain in the left hypochondrium and epigastric region;
• small "ruby droplets" appear on the body;
• characteristic feature is the presence of subcutaneous hemorrhage and cyanosis on the lateral surfaces of the abdomen or around the navel.

Diagnosis

Diagnosing chronic pancreatitis is difficult, especially in the early stages, as there are many diseases with similar signs. Therefore, the doctor needs to carry out a qualitative differential diagnosis, in which not only the data of a survey, examination of a patient, but also laboratory tests and instrumental methods of research help him. Currently, there are many modern diagnostic techniques that allow timely detection of the disease.

There is a compulsory complex of examinations that must be performed if there is a suspicion of chronic pancreatitis to every patient. Usually this is enough to confirm the diagnosis. In rare cases, additional diagnostic methods are required.

Mandatory survey methods :

1. General blood test, for protein, bilirubin, transaminases, lipase, sialic acids, trypsin, glucose, Y-glutamyltranspeptidase, a-amylase.
2. Fecal analysis - for scatology.
3. General analysis of urine, for a-amylase, proserin test.
4. The investigation of duodenal juice before the introduction of hydrochloric acid and after determines the enzymes of a-amylase, lipase, trypsin.
5. Duodenorentgenography with artificial hypotension;
6. Retrograde cholangiopancreatography;
7. Radioisotope scanning.

Laboratory tests

For accurate diagnosis, the following laboratory indicators should be known:

1. Blood tests;
2. Urinalysis;
3. Coprological analysis - with a clear violation of the excretory function, a maze-like consistency of stools is identified, with particles of unquenched fiber, steatorrhea, amylorea, creatorrhea;
4. Diagnosis of pancreatic functions

A general blood test shows an increase in ESR, during exacerbations, leukocytosis develops with a shift to the left.

Biochemical :

• in icteric form - content of trypsin, a-amylase, lipase, Y-globulins, seromucoid, sialic acids, bilirubin increases;
• in case of violation of the incretory function - increase in glucose level;
• with a long-term sclerosing form - reduces the level of albumin.

Urinalysis :

• with icteric form - on bilirubin, urobilin;
• during the exacerbation of the disease - an increase in α-amylase is detected;
• in case of impaired exocrine function - the level of a-amylase is reduced.
• prozerin test - allows you to determine the amount of a-amylase in the urine before and after the introduction of prosirin. Normally, it rises 1.8 times and after 2 hours it returns to normal, and in case of chronic pancreatitis it increases more than 2 times and after 2 hours it normalizes. With sclerosing form, the level of a-amylase before stimulation with proserin is below normal, and afterwards it does not increase.

Diagnosis of pancreatic function :

• excretory - is performed to determine the content of enzymes in the duodenum before and after the administration of a solution of hydrochloric acid, if there are violations, the number of enzymes will be reduced;
• endocrine - perform a test for glucose tolerance, if chronic pancreatitis is characterized by a prolonged course, it is reduced.

Radiography and retrograde cholangiopancreatography

An overview radiography allows us to identify calcinates in pancreatic tissue, and if it is enlarged we can detect gastric ups and downs, as well as enlargement of the duodenal loop and compaction of the lower part of the duodenum.

Retrograde cholangiopancreatography - can determine duct stenosis and the location of obstruction, detect changes in its structure, calcification, and protein stoppers. This study has high diagnostic informativeness, however, the procedure is quite invasive, and this does not exclude the possibility of complications: cholangitis, acute pancreatitis, sepsis and allergic reactions. Therefore, during the ERCPHG, the patient is placed in the surgical department.

Computed tomography

The study using computed tomography has several advantages over ultrasound, it is based on irradiation with x-rays in the pancreas.

This allows to identify a characteristic tissue swelling, calcium deposits, which can not be detected by X-ray examination, especially in patients with excessive body weight.

Radioisotope scanning

This survey method is based on the introduction into the patient's body of a radioactive isotope. After this, using the special equipment determine the level of radiation of the substance in the pancreas. The received information is recorded in the form of a diagram.

Radioisotope scanning can diagnose tumor processes, signs of metabolic disorders, detect bleeding and determine the movement of blood, assess the level of radioactive contamination of the body.

Only after qualitative differential diagnosis and examination of the patient, the physician will be able to prescribe the necessary and effective treatment. Therefore, at the first sign of malaise, you should immediately consult a doctor.

Interview with a gastroenterologist about chronic hepatitis