Abstract
The investigation of pancreatic disease remains problematical and unsatisfactory despite the introduction of a host of techniques. The use of MRCP, EUS, ultrasonography or CT to define the anatomy of the gland, coupled with one of the tests of exocrine secretion is probably the most satisfactory method of assessment. Estimation of steatorrhoea, glucose tolerance and serum amylase can provide valuable additional information. These tests are required to determine whether pancreatic disease is present and, if so, its nature. The differentiation of chronic pancreatitis from pancreatic cancer is an important though often unresolved question. The laboratory diagnosis of pancreatic disease can be quite simple in the presence of jaundice, glycosuria or steatorrhoea; it is when the only symptom is abdominal pain that the diagnosis frequently proves extremely difficult.
Bibliography
Acosta M, Ledesma CL. Gallstone migration as a cause of acute pancreatitis. N Engl J Med. 1974;290:484–7.
Adrian TE, Bloom SR, Bryant MG, Polak JM, Heitz PH, Barnes AJ. Distribution and release of human pancreatic polypeptide. Gut. 1976;17:940–4.
Adrian TE, Uttenthal LO, Williams SJ, Bloom SR. Secretion of pancreatic polypeptide in patients with pancreatic endocrine tumours. N Engl J Med. 1986;315:287–91.
Arvanitakis C, Cook AR. Diagnostic tests of exocrine pancreatic function and disease. Gastroenterology. 1978;74:932–48.
Axon ATR, Classen M, Cotton PB, Cremer M, Freeny PC, Lees WR. Pancreatography in chronic pancreatitis. Gut. 1984;2:1107–12.
Bams RJ, Elmslie RG. Comparison of methods for estimation of trypsin in duodenal fluid. Clin Chim Acta. 1975;58:165–71.
Barry RE, Barry R, Ene MD, Parker G. Fluorescein dilaurate – tubeless test for pancreatic exocrine failure. Lancet. 1982;2:742–4.
Bloom SR, Polak JM. Plasma hormone concentrations in gastrointestinal disease. Clin Gastroenterol. 1980;9:785–98.
Bonin A, Roy CC, Lasalle R, Weber A, Morin CL. Faecal chymotrypsin: a reliable index of exocrine pancreatic function in children. J Paediatr. 1973;83:594–60.
Bray PT, Clark GCF, Moody GJ, Thomas IDR. Sweat testing for cystic fibrosis: errors associated with the in-situ sweat test using chloride ion selective electrodes. Clin Chim Acta. 1977;80:333–8.
Crossley JR, Elliott RB, Smith PA. Dried blood-spot screening for cystic fibrosis in the new born. Lancet. 1979;1:472–4.
Cuschieri A, Hall AW, Clark J. Value of laparoscopy in the diagnosis and management of pancreatic carcinoma. Gut. 1978;19:672–7.
Denning CR, Huang NN, Cuasay LR, et al. Co-operative study comparing 3 methods of performing sweat tests in cystic fibrosis. Paediatrics. 1980;66:752–7.
Deutsch V, Adar R, Jacob ET, Bank H, Moles M. Angiographic diagnosis and differential diagnosis of islet-cell tumours. Am J Roentgenol. 1973;119:121–32.
Duncan JG, Imrie CW, Blumgart LH. Ultrasound in the management of acute pancreatitis. Br J Radiol. 1976;49:858–62.
Durr HK, Otte M, Forell MM, Ie B. Faecal chymotryspin: a study on its diagnostic value by comparison with the secretin-CCK test. Digestion. 1978;17:404–9.
Editorial. Cystic fibrosis: prospects for screening and therapy. Lancet. 1990;335:79–80.
Elias E, Redshaw M, Wood T. Diagnostic importance of changes in circulating concentration of immunoreactive trypsin. Lancet. 1977;2:66–8.
Fawcett RA, Forbes WSC, Isherwood I, Braganza JM, Howat HT. Computed tomography in pancreatic disease. Br J Radiol. 1978;51:1–4.
Fedai SS, Harvey RF, Salmon PR, Brown P, Read AE. Trypsin and lactoferrin levels in pure pancreatic juice in patients with pancreatic disease. Gut. 1979;20:983–6.
Foster PN, Mitchell CJ, Robertson DRC, et al. Prospective comparison of three non-invasive tests for pancreatic disease. BMJ. 1984;289:13–6.
Gibson LE, Cooke RE. A test for concentration of electrolytes in sweat in cystic fibrosis of the pancreas using pilocarpine by iontophoresis. Paediatrics. 1959;23:545–9.
Gordon I, Levin B, Whitehead TP. Estimation of trypsin in duodenal juice. BMJ. 1952;1:463–5.
Hatfield ARW, Smithies A, Wilkins R, Levi AJ. Assessment of ERCP and pure pancreatic juice cytology in patients with pancreatic disease. Gut. 1976;17:14–21.
Haverback B, Dyce BJ, Gutentag PJ, Montgomeray DW. Measurement of trypsin and chymotrypsin in stool: a diagnostic test for pancreatic exocrine insufficiency. Gastroenterology. 1963;44:588–97.
Heeley AF, Heeley ME, King DN, Kuzemko JA, Walsh MP. Screening for cystic fibrosis by dried blood spot trypsin assay. Arch Dis Child. 1982;57:18–21.
Herlinger H, Finaly DBL. Evaluation and follow-up of pancreatic arteriograms. A new role for angiography in the diagnosis of carcinoma of the pancreas. Clin Radiol. 1978;29:277–84.
Hodson M, Beldon I, Power R, Duncan FR, Bamber M, Batten JC. Sweat tests to diagnose cystic fibrosis in adults. BMJ. 1983;386:1381–3.
Hovdenak N, Lees WR, Pereira J, Beilby JOW, Cotton PB. Ultrasound-guided percutaneous fineneedle aspiration cytology of the pancreas. BMJ. 1982;285:1183–4.
Iwase K, Kato K, Nagasaka H, et al. Immunohistochemical study of neuro-specific enolase (NSE) and CA19-9 in pancreatic disorders. Gastroenterology. 1986;91:576–80.
Jacobson DG, Curington C, Connery K, Toskes PP. Trypsin-like immunoreactivity as a test for pancreatic insufficiency. N Engl J Med. 1984;310:1307–9.
Johnstone DE. Studies of cystic fibrosis of the pancreas. Am J Dis Child. 1952;84:191–8.
Junglee D, Penketh A, Katrak A, Hodson ME, Batten JC, Dandona P. Serum pancreatic lipase activity in cystic fibrosis. BMJ. 1983;286:1693–4.
Lake-Bakaar G, McKavanagh S, Rubio CE, Epstein O, Summerfield JO. Measurement of trypsin in duodenal juice by radio-immunoassay. Gut. 1980;21:402–7.
Lankisch PG, Brauneis J, Otto J, Goke B. Pancreolauryl and NBT-PABA tests. Are serum tests more practicable alternatives to urine tests in the diagnosis of exocrine pancreatic insufficiency? Gastroenterology. 1986;90:350–4.
Lankisch PO. Exocrine pancreatic function tests. Gut. 1988;23:777–98.
Larvin M, Chalmers AG, McMahon M. Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis. BMJ. 1990;300:1425–8.
Lees WR, Vallon AG, Denyer ME, Vahl SP, Cotton PB. Prospective study of ultrasonography in chronic pancreatic disease. BMJ. 1979;1:162–4.
London NJM, Neoptolemos JP, Lavelle J, Bailey I, James D. Serial computed tomography scanning in acute pancreatitis: a prospective study. Gut. 1989;30:397–403.
Lundh G. Pancreatic exocrine function in neoplastic and inflammatory disease: a simple and reliable new test. Gastroenterology. 1962;47:275–80.
Mackie CR, Cooper MJ, Lewis MH, Moossa AR. Non-operative differentiation between pancreatic cancer and chronic pancreatitis. Ann Surg. 1979a;189:480–7.
Mackie CR, Dhorajiwala J, Blackstone MO, Bowie J, Moossa AR. Value of new diagnostic aids in relation to the disease process in pancreatic cancer. Lancet. 1979b;2:385–9.
Moeller DO, Dunn GO, Klotz AP. Comparison of the pancreozymin-secretin test and the Lundh test meal. Am J Dig Dis. 1972;17:799.
Mottaleb A, Kapp F, Noguera ECA, Kellock TO, Wiggins HS, Waller SL. The Lundh test in the diagnosis of pancreatic disease: a review of 5 years experience. Gut. 1973;14:835–41.
Multigner L, Figarella C, Samel J, Sarles J. Lactoferrin and albumin in human pancreatic juice. Dig Dis Sci. 1980;125:173–8.
Nasrallah SM, Martin DM. Serum isoamylase as a test for pancreatic insufficiency. Gut. 1983;24:161–4.
Nishida K, Sugira M, Yoshikawa T, Kond M. Enzyme immunoassay of pancreatic oncofetal antigen (POA). Gut. 1985;26:450–5.
Osne M, Serck-Hanssen A, Kristensen O, Swensen T, Aune S, Myren J. Endoscopic retrograde brush cytology in patients with primary and secondary malignancies of the pancreas. Gut. 1979;20:279–84.
Reuben A, Johnson AL, Cotton PB. Is the pancreatogram reliable? A study of observer variation and error. Br J Radiol. 1978;51:956–62.
Russell JGB, Vallon AG, Braganza JM, Howatt HT. Ultrasonic scanning in pancreatic disease. Gut. 1978;19:1027–33.
Sakamoto K, Haga Y, Yoshimura R, Egami H, Yokoyama Y, Akagi M. Comparative effectiveness of the tumour diagnostics CAI9-9, CA125 and CEA in patients with diseases of the digestive system. Gut. 1987;28:323–9.
Salt WB, Schenker S. Amylase – its clinical significance: a review of the literature. Medicine. 1967;55:269–89.
Shorey BA. Aspiration biopsy of carcinoma ofthe pancreas. Gut. 1975;16:645–7.
Smith EH, Bartrum RJ, Chang YC, D’Orsi CJ, Lokich J, Abbruzzese A, Dantano J. Percutaneous aspiration biopsy of the pancreas under ultrasonic guidance. N Engl J Med. 1975;292:825–8.
Steinberg WM, Gelfand R, Anderson KK, et al. Comparison of the sensitivity and specificity of the CA19-9 and CEA assays in detecting cancer of the pancreas. Gastroenterology. 1986;90:343–9.
Steinberg WM, Goldstein SS, Davis ND, Shama’a J, Anderson K. Diagnostic assays in acute. pancreatitis. Ann Intern Med. 1985;102:576–80.
Stoupis C, Dervenis C, Buchler MW. Current imaging techniques in acute pancreatitis. Hellenic J Gastroenterol. 1995;894:299–303.
Tulassay Z, Sandor Z, Bodrogi L, Papp J, Feher T. An endocrine marker for pancreatic cancer. BMJ. 1988;297:1447–4.
Walsh JH, Tomkins RK, Taylor IL, Lechago J, Hansky J. Gastrointestinal hormones in clinical disease: recent developments. Ann Intern Med. 1979;90:817–28.
Warwick WJ, Hansen L. Measurement of chloride in sweat with the chloride selective electrode. Clin Chem. 1978;24:2050–3.
Wiggans G, Schein PS, Macdonald JS, Schellinger D, Harbert D. Computerised axial tomography for diagnosis of pancreatic cancer. Lancet. 1976;2:233–5.
Wong LTK, Turtle S, Davidson AGF. Secretin pancreozymin stimulation test and confirmation of the diagnosis of cystic fibrosis. Gut. 1982;23:744–50.
Youngs GR, Agnew JE, Levin GE, Bouchier lAD. A comparative study of 4 tests of pancreatic function in the diagnosis of pancreatic disease. Q J Med. 1973;42:597–618.
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Bateson, M.C., Bouchier, I.A.D. (2017). Pancreas. In: Clinical Investigations in Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-53786-3_11
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