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A1_ A 43-year-old man is evaluated for a one-year history of chronic abdominal pain. He describes episodes of epigastric and left upper quadrant pain that last for hours and are not relieved by antacids. Certain foods can precipitate the pain. He also complains of occasional diarrhea. The patient has lost 10 pounds over the last 6 months. Fouryears ago he was hospitalized for three days with acute abdominal pain. He smokes one pack erf cigarettes a day and consumes alcohol regularly. His family history is significant for diabetes mellitus in his mother and prostate cancer in his father. Which of the foHowing is most likely to diagnose this patienf s condition?
A. D-xylose absorption test
B. Serum amylase and lipase
C. Radioisotope (HIDA) scan
D CA19-9 and CEA levels
E. Stool elastase
F. Upper Gl endoscopy
G. Liver biopsy
*** THANKS and Enjoy guys, i will post the ans once i come back from lunch. GL
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Thank you Drkhmer.
E. Stool elastase
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_ Hi Rammar, it's been a while not to see you here, but finally i pull you out.
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LOL, Thanx again for those nice questions.
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_ The correct ans is EEE.
An alcoholic patient presenting with chronic abdominal pain and diarrhea is classic for chronic pancreatitis. This disorder, resulting from chronic inflammation of the pancreas, is characterized by abdominal pain and symptoms of pancreatic insufficiency. Pancreatic insufficiency usually manifests first as exocrine dysfunction, with patients experiencing diarrhea due to fat malabsorption. However, the condition may progress to include diabetes from pancreatic endocrine failure. Weight loss from chronic diarrhea is common.
The diagnosis of chronic pancreatitis can be somewhat tricky. Serum amylase and lipase concentrations may be modestly elevated but are more commonly normal. This is because there is significant fibrosis and only patch/ inflammation in chronic pancreatitis (as opposed to the widespread inflammation seen in acute pancreatitis). Stool elastase measurement can be beneficial in diagnosing malabsorption secondary to pancreatic exocrine insufficiency. This testis the most sensitive and specific test for pancreatic insufficiency and requires only one stool sample.
(Choice A) The D-xylose absorption test is used to diagnose a variety of carbohydrate malabsorptive syndromes. This test is typically normal in patients with pancreatic insufficiency because pancreatic enzymes are not required for xylose to be absorbed.
(Choice C) Radioisotope (HiDA) scanning is used to cfiagnose acute cholecystitis.
(Choice D) Serum CA 19-9 and CEA levels are elevated in a number of upper gastrointestinal tumors. They are used to follow response to therapy or disease recurrence but should not be used to diagnose a neoplasm.
(Choice F) Upper Gl endoscopy (esophagogastroduodenoscopy. or EGD) is used to diagnose luminal defects in the upper Gl system. In particular, EGD can be helpful in evaluating patients with peptic ulcer disease, gastritis, dysphagia, or upper Gl bleeds. An EGD may be a reasonable future test for this patient if he continues to have abdominal pain and proves not to have chronic pancreatitis.
(Choice G) This patient has symptoms of pancreatic insufficiency, not hepatic failure.
Educational Objective:
Chronic pancreatitis is an inflammatory condition characterized by chronic abdominal pain and pancreatic insufficiency. A fecal elastase study is the most sensitive and specific test to diagnose pancreatic exocrine failure.
