Diseases of the Pancreas, I: Pancreatitis

  • Thomas Helmberger


The incidence of pancreatic inflammatory diseases in the Western world is 110–240 cases/1 million individuals. In about 80% of these cases, the underlying cause is an undetected gall stone disease or alcohol abuse. The former is more prevalent in women and the latter in men, especially those between 30 and 50 years of age. Nevertheless, there are many other factors that can cause pancreatitis (Table 1)
Table 1.

Potential causes of pancreatitis


Pancreatic Cancer Acute Pancreatitis Common Bile Duct Chronic Pancreatitis Pancreatic Duct 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. 1.
    Mitchell RM, Byrne MF, Baillie J (2003) Pancreatitis. Lancet 361:1447–1455CrossRefPubMedGoogle Scholar
  2. 2.
    Glasbrenner B, Kahl S, Malfertheiner P (2002) Modern diagnostics of chronic pancreatitis. Eur J Gastroenterol Hepatol 14:935–941CrossRefPubMedGoogle Scholar
  3. 3.
    Etemad B, Whitcomb DC (2001) Chronic pancreatitis: diagnosis, classification, and new genetic developments. Gastroenterology 120:682–707CrossRefPubMedGoogle Scholar
  4. 4.
    Halonen KI, Leppaniemi AK, Puolakkainen PA et al (2000) Severe acute pancreatitis: prognostic factors in 270 consecutive patients. Pancreas 21:266–271CrossRefPubMedGoogle Scholar
  5. 5.
    Bank S, Indaram A (1999) Causes of acute and recurrent pancreatitis. Clinical considerations and clues to diagnosis. Gastroenterol Clin North Am 28:571–89, viiiCrossRefPubMedGoogle Scholar
  6. 6.
    Cavallini G, Frulloni L, Bassi C et al (2004) Prospective multicentre survey on acute pancreatitis in Italy (ProInf-AISP): results on 1005 patients. Dig Liver Dis 36:205–211CrossRefPubMedGoogle Scholar
  7. 7.
    Losanoff JE, Asparouhov OK, Jones JW (2001) Multiple factor scoring system for risk assessment of acute pancreatitis. J Surg Res 101:73–78CrossRefPubMedGoogle Scholar
  8. 8.
    Plock JA, Schmidt J, Anderson SE et al (2005) Contrast-enhanced computed tomography in acute pancreatitis: does contrast medium worsen its course due to impaired microcirculation? Langenbecks Arch Surg 390:156–163CrossRefPubMedGoogle Scholar
  9. 9.
    Werner J, Schmidt J, Warshaw AL et al (1998) The relative safety of MRI contrast agent in acute necrotizing pancreatitis. Ann Surg 227:105–111CrossRefPubMedGoogle Scholar
  10. 10.
    Robinson PJ, Sheridan MB (2000) Pancreatitis: computed tomography and magnetic resonance imaging. Eur Radiol 10:401–408CrossRefPubMedGoogle Scholar
  11. 11.
    Pamuklar E, Semelka RC (2005) MR imaging of the pancreas. Magn Reson Imaging Clin N Am 13:313–330CrossRefPubMedGoogle Scholar
  12. 12.
    Laurens B, Leroy C, André A et al (2005) [Imaging of acute pancreatitis]. J Radiol 86:733–46; quiz 746–747CrossRefPubMedGoogle Scholar
  13. 13.
    Vaishali MD, Agarwal AK, Upadhyaya DN et al (2004) Magnetic resonance cholangiopancreatography in obstructive jaundice. J Clin Gastroenterol 38:887–890CrossRefPubMedGoogle Scholar
  14. 14.
    Arvanitakis M, Delhaye M, De Maertelaere V et al (2004) Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis. Gastroenterology 126:715–723CrossRefPubMedGoogle Scholar
  15. 15.
    Akahane T, Kuriyama S, Matsumoto M et al (2003) Pancreatic pleural effusion with a pancreaticopleural fistula diagnosed by magnetic resonance cholangiopancreatography and cured by somatostatin analogue treatment. Abdom Imaging 28:92–95CrossRefPubMedGoogle Scholar
  16. 16.
    Sica GT, Miller FH, Rodriguez G et al (2002) Magnetic resonance imaging in patients with pancreatitis: evaluation of signal intensity and enhancement changes. J Magn Reson Imaging 15:275–284CrossRefPubMedGoogle Scholar
  17. 17.
    Okai T, Fujii T, Ida M et al (2002) EUS and ERCP features of nonalcoholic duct-destructive, mass-forming pancreatitis before and after treatment with prednisolone. Abdom Imaging 27:74–76CrossRefPubMedGoogle Scholar
  18. 18.
    Taylor SL, Morgan DL, Denson KD et al (2005) A comparison of the Ranson, Glasgow, and APACHE II scoring systems to a multiple organ system score in predicting patient outcome in pancreatitis. Am J Surg 189:219–222CrossRefPubMedGoogle Scholar
  19. 19.
    Mentula P, Kylänpää ML, Kemppainen E et al (2005) Early prediction of organ failure by combined markers in patients with acute pancreatitis. Br J Surg 92:68–75CrossRefPubMedGoogle Scholar
  20. 20.
    Leung TK, Lee CM, Lin SY et al (2005) Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome. World J Gastroenterol 11:6049–6052PubMedGoogle Scholar
  21. 21.
    Johnson CD, Toh SK, Campbell MJ (2004) Combination of APACHE-II score and an obesity score (APACHE-O) for the prediction of severe acute pancreatitis. Pancreatology 4:1–6CrossRefPubMedGoogle Scholar
  22. 22.
    Gerlach H (2004) Risk management in patients with severe acute pancreatitis. Crit Care 8:430–432CrossRefPubMedGoogle Scholar
  23. 23.
    King NK, Powell JJ, Redhead D, Siriwardena AK (2003) A simplified method for computed tomographic estimation of prognosis in acute pancreatitis. Scand J Gastroenterol 38:433–436CrossRefPubMedGoogle Scholar
  24. 24.
    Triester SL, Kowdley KV (2002) Prognostic factors in acute pancreatitis. J Clin Gastroenterol 34:167–176CrossRefPubMedGoogle Scholar
  25. 25.
    Sandberg AA, Borgstrom A (2002) Early prediction of severity in acute pancreatitis. Is this possible? Jop 3:116–125Google Scholar
  26. 26.
    Balthazar EJ (2002) Staging of acute pancreatitis. Radiol Clin North Am 40:1199–1209CrossRefPubMedGoogle Scholar
  27. 27.
    Balthazar EJ (2002) Acute pancreatitis: assessment of severity with clinical and CT evaluation. Radiology 223:603–513CrossRefPubMedGoogle Scholar
  28. 28.
    Mortele KJ, Wiesner W, Intriere L et al (2004) A modified CT severity index for evaluating acute pancreatitis: improved correlation with patient outcome. AJR Am J Roentgenol 183: 1261–1265PubMedGoogle Scholar
  29. 29.
    Mofidi R, Patil PV, Suttie SA, Parks RW (2009) Risk assessment in acute pancreatitis. Br J Surg 96:137–150CrossRefPubMedGoogle Scholar
  30. 30.
    Irie H, Honda H, Kuroiwa T et al (1998) MRI of groove pancreatitis. J Comput Assist Tomogr 22:651–5CrossRefPubMedGoogle Scholar
  31. 31.
    Gabata T, Kadoya M, Terayama N et al (2003) Groove pancreatic carcinomas: radiological and pathological findings. Eur Radiol 13:1679–1684CrossRefPubMedGoogle Scholar
  32. 32.
    Shanbhogue AK, Fasih N, Surabhi VR et al (2009) A clinical and radiologic review of uncommon types and causes of pancreatitis. Radiographics 29:1003–1026CrossRefPubMedGoogle Scholar
  33. 33.
    Triantopoulou C, Dervenis C, Giannakou N et al (2009) Groove pancreatitis: a diagnostic challenge. Eur Radiol 19:1736–1743CrossRefPubMedGoogle Scholar
  34. 34.
    Okazaki K (2005) Autoimmune pancreatitis: etiology, pathogenesis, clinical findings and treatment. The Japanese experience. Jop 6(1 Suppl):89–96PubMedGoogle Scholar
  35. 35.
    Takahashi N, Fletcher JG, Hough DM et al (2009) Autoimmune pancreatitis: differentiation from pancreatic carcinoma and normal pancreas on the basis of enhancement characteristics at dual-phase CT. AJR Am J Roentgenol 193:479–484CrossRefPubMedGoogle Scholar
  36. 36.
    Weili L, Jiaguo W (2009) Education and imaging: Hepatobiliary and pancreatic: autoimmune pancreatitis. J Gastroenterol Hepatol 24:1574CrossRefPubMedGoogle Scholar
  37. 37.
    Sahani DV, Kalva SP, Farrell J et al (2004) Autoimmune pancreatitis: imaging features. Radiology 233:345–352CrossRefPubMedGoogle Scholar
  38. 38.
    Farrell JJ, Garber J, Sahani D, Brugge WR (2004) EUS findings in patients with autoimmune pancreatitis. Gastrointest Endosc 60:927–936CrossRefPubMedGoogle Scholar
  39. 39.
    Wakabayashi T, Kawaura Y, Satomura Y et al (2003) Clinical and imaging features of autoimmune pancreatitis with focal pancreatic swelling or mass formation: comparison with socalled tumor-forming pancreatitis and pancreatic carcinoma. Am J Gastroenterol 98:2679–2687CrossRefPubMedGoogle Scholar
  40. 40.
    Ito K, Koike S, Matsunaga N (2001) MR imaging of pancreatic diseases. Eur J Radiol 38:78–93CrossRefPubMedGoogle Scholar
  41. 41.
    Irie H, Honda H, Baba S et al (1998) Autoimmune pancreatitis: CT and MR characteristics. AJR Am J Roentgenol 170:1323–1327PubMedGoogle Scholar
  42. 42.
    Sahani DV, Sainani NI, Deshpande V et al (2009) Autoimmune pancreatitis: disease evolution, staging, response assessment, and CT features that predict response to corticosteroid therapy. Radiology 250:118–129CrossRefPubMedGoogle Scholar
  43. 43.
    Sainani NI, Conwell DL (2009) Secretin-enhanced MRCP: proceed with cautious optimism. Am J Gastroenterol 104:1787–1789CrossRefPubMedGoogle Scholar
  44. 44.
    Yamada Y, Mori H, Matsumoto S et al (2009) Pancreatic adenocarcinoma versus chronic pancreatitis: differentiation with triple-phase helical CT. Abdom Imaging 22Google Scholar
  45. 45.
    Lowenfels AB, Maisonneuve P, Cavallini G et al (1994) Prognosis of chronic pancreatitis: an international multicenter study. International Pancreatitis Study Group. Am J Gastroenterol 89:1467–1471PubMedGoogle Scholar
  46. 46.
    Tang S, Huang G, Liu J et al (2009) Usefulness of (18)F-FDG PET, combined FDG-PET/CT and EUS in diagnosing primary pancreatic carcinoma: A meta-analysis. Eur J Radiol (in press)Google Scholar
  47. 47.
    Cho SG, Lee DH, Lee KY et al (2005) Differentiation of chronic focal pancreatitis from pancreatic carcinoma by in vivo proton magnetic resonance spectroscopy. J Comput Assist Tomogr 29:163–9CrossRefPubMedGoogle Scholar
  48. 48.
    van Kouwen MC, Jansen JB, van Goor H et al (2005) FDGPET is able to detect pancreatic carcinoma in chronic pancreatitis. Eur J Nucl Med Mol Imaging 32:399–404CrossRefPubMedGoogle Scholar
  49. 49.
    Manfredi R, Lucidi V, Gui B et al (2002) Idiopathic chronic pancreatitis in children: MR cholangiopancreatography after secretin administration. Radiology 224:675–682CrossRefPubMedGoogle Scholar
  50. 50.
    DeBanto JR, Goday PS, Pedroso MR et al (2002) Acute pancreatitis in children. Am J Gastroenterol 97:1726–1731CrossRefPubMedGoogle Scholar
  51. 51.
    Levy MJ, Geenen JE (2001) Idiopathic acute recurrent pancreatitis. Am J Gastroenterol 96:2540–2555CrossRefPubMedGoogle Scholar

Copyright information

© Springer Verlag Italia 2010

Authors and Affiliations

  • Thomas Helmberger
    • 1
  1. 1.Institute of Diagnostic and Interventional Radiology and Nuclear MedicineKlinikum BogenhausenMunichGermany

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