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Diagnostic workup of patients with pancreatic diseases

Diagnostik bei Pankreas-Erkrankungen

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Zusammenfassung

GRUNDLAGEN: Zu den Erkrankungen der Bauchspeicheldrüse gehören eine große Zahl unterschiedlicher Krankheitsbilder, die von angeborenen Fehlbildungen über entzündliche Erkrankungen wie der akuten und chronischen Pankreatitis, über Neoplasien epithelialen, mesenchymalen und neuroendokrinen Ursprungs, bis zu erblichen Erkrankungen, die mit Keimbahnmutationen einhergehen und bis zur Autoimmunpankreatitis reichen. METHODIK: Im folgenden Artikel werden nicht nur die Stärken und Schwächen der am häufigsten verwendeten Laboruntersuchungen und bildgebenden Verfahren dargestellt, zu denen der endoskopische Ultraschall, die Computertomographie und die Kernspintomographie gehören, sondern auch die Indikationen für genetische Untersuchungen und Funktionstests. Seltene Erkrankungen, die häufig eine Herausforderung für die Differentialdiagnose darstellen und erbliche Prädispositionen für die Pankreatitis und das Pankreaskarzinom werden ebenfalls diskutiert. ERGEBNISSE UND SCHLUSSFOLGERUNGEN: Das Spektrum der diagnostischen Verfahren, die in der Klinik für die Differentialdiagnose bei Patienten mit Pankreaserkrankungen eingesetzt und auch bei deren Verwandten mit hohem Erkrankungsrisiko verwendet werden, ist deshalb außerordentlich breit. Es reicht von einfachen klinisch-chemischen Untersuchungen über Funktionsuntersuchungen für die endokrine und exokrine Pankreasinsuffizienz bis zu bildgebenden Verfahren und Gentests.

Summary

BACKGROUND: Pancreatic disorders comprise a large number of entities that include congenital malformations, inflammatory disorders such as acute and chronic pancreatitis, neoplasias of epithelial, mesenchymal, and neuroendocrine origin, inherited disorders that are associated with germline mutations and autoimmune pancreatitis. METHODS: The following article will not only review the strength and weaknesses of the most commonly used laboratory tests and imaging modalities such as endoscopic ultrasound, CT scanning, and MRI but also outline the indications for genetic studies and function tests. Rare disorders that often present as a challenging differential diagnosis and genetic predispositions for pancreatitis and pancreatic cancer will also be covered. RESULTS AND CONCLUSIONS: The spectrum of diagnostic tests being used for the clinical work-up of patients with pancreatic disorders and at-risk relatives is accordingly broad. It ranges from simple clinical chemistry to function tests for endocrine and exocrine insufficiency, to imaging techniques and genetic testing.

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Authors and Affiliations

  1. Departments of Medicine A, Surgery and Radiology, Ernst-Moritz-Arndt Universität Greifswald, Greifswald, Germany

    M. Kraft, P. Simon, A. Aghdassi, C. D. Heidecke, G. Sauter, J.-P. Kühn, F. U. Weiss, M. M. Lerch & J. Mayerle

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  1. M. Kraft
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  2. P. Simon
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  3. A. Aghdassi
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  4. C. D. Heidecke
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  5. G. Sauter
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  6. J.-P. Kühn
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  7. F. U. Weiss
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  8. M. M. Lerch
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  9. J. Mayerle
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Correspondence to M. M. Lerch.

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Kraft, M., Simon, P., Aghdassi, A. et al. Diagnostic workup of patients with pancreatic diseases. Eur Surg 41, 268–279 (2009). https://doi.org/10.1007/s10353-009-0500-y

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