By Prof. Dr. med. P. G. Lankisch, Prof. Dr. med. M. Büchler, Prof. Dr. med. J. Mössner, Prof. Dr. S. Müller-Lissner (auth.)
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Extra resources for A Primer of Pancreatitis
B vitamins in the case of nutritional deficiency due to chronic alcoholism Endocrine insufficiency • Oral antidiabetics effective only transiently • Insulin 57 Chronic pancreatitis Operative endoscopy Drainage Prior to long term drainage a pseudocyst should be emptied once without insertion of a drain because not all cysts do recur. This may be done percutaneously under ultrasound guidance. If the cyst recurs drainage can be attempted by endoscopic stent placement after previous localisation with endoscopic ultrasound and/or CT.
The following methods of examination are of minor diagnostic value: Barium meal examination of the upper gastrointestinal tract If duodenal stenosis is suspected, it is performed before surgery. Angiography This is indicated when planning surgery if there are vascular complications. Magnetic resonance tomography (MRT) This provides no extra information compared to ultrasound and/or CT. 40 Diagnosis: overview Morphological examinations • Ultrasound • Endoscopic retrograde cholangiopancreaticography (ERCP) • Computed tomography • Plain abdominal X-ray Function tests • Indirect pancreatic function tests • Direct pancreatic function tests • Faecal fat analysis • Oral glucose tolerance test 41 Chronic pancreatitis Symptoms Pain The pain mosdy takes an undulating or intermittent course and can impair the quality of life decisively.
After excluding other causes of steatorrhoea, the quantitative assay of faecal fat excretion is a measure of exocrine insufficiency. It can be used to confirm the adequacy of enzyme supplementation therapy. Glucose metabolism. The determination of fasting and postprandial glucose levels is sufficient for the diagnosis of endocrine insufficiency. Preoperative tests of function. A check of exocrine and endocrine function is helpful for deciding between resection and drainage. If function is already severely impaired, there is no need to carefully spare remaining pancreatic tissue.
A Primer of Pancreatitis by Prof. Dr. med. P. G. Lankisch, Prof. Dr. med. M. Büchler, Prof. Dr. med. J. Mössner, Prof. Dr. S. Müller-Lissner (auth.)