A patient complains of epigastric pain, radiating to back off and on. The investigation of choice is:
B i.e. CT Scan Stepwise diagnostic approch to a patients with suspected chronic pancreatitis. CT scan (calcification, atrophy &/or dilated duct seen for diagnosis) MRI/MRCP with secretin-enhancement (sMRCP) (Diagnostic criteria=Cambridge class III, dilated duct, atrophy of gland, filling defect in duct suggestive of stone) Endoscopic ultrasound (EUS) with quantification (5) of parenchymal & ductal criteria Pancreatic function test (with secretin)- gastroduodenal (SST) or endoscopic (ePFT) collection method. Diagnostic criteria: peak <80meq/L Endoscopic Retrograde Cholangio pancreaticography (ERCP) DC: Cambridge III, dilated main pancreatic duct & >3 dilated side branch Acute Pancreatitis Any severe acute pain in abdomen or back should suggest the possibility of acute pancreatitis. Abdominal pain,is the major symptom of acute pancreatitis characteristically, the pain which is steady & boring in character, is located in epigastrium & periumbilical regionQ and often radiates to the backQ as well as to the chest, flank & lower abdomen. The patient often obtains relief by sitting with the trunk flexed and knees drawn upQ. When a patient with possible predisposition to pancreatitis (such as gall stone, alcoholism, ERCP, hyperigyceridemia, trauma, surgery and drugs like azathioprine, sulfonamides, estrogen, tetracycline, valproic acid, 6-merceptopurine & anti HIV drugs) presents with severe & constant abdominal pain frequently a/w nausea, fever, emesis, tachycardia, leukocytosis, hypocalcemia and hyperglycemia, the diagnosis of acute pancreatitis is usually enteained. Diagnosis of acute pancreatitis requires 2 of the following: typical abdominal pain, 3 fold or greater increase in serum amylase &/or lipase (which usually establishes/clinch the diagnosis if gut perforation, ischemia or infraction are excluded, however, levels does not indicate the severity) and confirmatory findings on cross sectional abdominal imaging. A CTscan can confirm the diagnosis of acute pancreatitisQ even with less than a 3 fold increase in serum amylase and lipase levels. It also indicates severity of disease, risk of morbidity and moality and evaluates complication of acute pancreatitis. However, a CTscan within 3-5 days of symptom onset may underestimate the extent of tissue injury (hence repeated again). Sonography is useful to evaluate gallbladder if gall stone disease is suspected as etiology.
MRI
CT Scan
USG
Radio nucleotide scan