Answer to Gastroenterology MCQ 68

The answer is D.

Patients with small duct pancreatitis in contrast to those with large duct chronic pancreatitis, which is largely related to alcohol, do not progress to steatorrhea, in fact these patients, observed over many years always have chronic abdominal pain as their symptom. Small duct pancreatitis is usually not caused by alcohol. Alcohol abuse leads to large duct chronic pancreatitis. Small duct chronic pancreatitis is often in the category of idiopathic chronic pancreatitis. Calcifications are very uncommon in patients with small duct chronic pancreatitis in marked contrast to those with large duct chronic pancreatitis. Unexplained abdominal pain in a patient in must lead to the high suspicion that this could be CT scan negative and sometimes ERCP negative, chronic pancreatitis of the small duct variety. Such patients are best detected by a hormone stimulation test such as a secretin test. The secretin test is only done in about 10 centers throughout the United States, but by far, is the best test to detect such pancreatitis when radiographic examinations are normal. EUS may have a role in this regard, but at the present time, it appears that EUS cannot be recommended as a consistent diagnostic test in such patients suspected of having small duct chronic pancreatitis. Recent studies have compared the sensitivity and specificity of patients who ultimately are shown to have small chronic pancreatitis with a secretin test and in at least two studies done at two independent university medical centers, the sensitivity was about 55% and the specificity about 60% in comparing EUS to the secretin test.

Category: Gastroenterology MCQs