Differentiating acute and chronic pancreatitis may be difficult during an exacerbation, since the primary distinction is based on disease reversibility. 2 Laboratory investigations are nonspecific in chronic pancreatitis. Amylase and lipase levels may be elevated but have no prognostic significance and are usually normal, particularly when fibrosis is advanced. Glucose tolerance is often impaired, occasionally with an elevated fasting blood sugar level. In 5 to 10 percent of patients with chronic pancreatitis, compression of the intrahepatic portion of the bile duct leads to elevations of bilirubin and alkaline phosphatase levels. 19 Pancreatic calcification on abdominal radiographs is considered pathognomonic for chronic pancreatitis and is present in some 30 percent of patients, particularly those with alcohol-induced disease.1 22 Lists of diagnostic criteria for chronic pancreatitis have been developed since no single gold standard exists. 23 Either CI or ultrasound may be indicated to identify local complications of chronic pancreatitis, such as abscess or pseudocyst. Ihe differentiation between chronic pancreatitis and pancreatic cancer can be challenging and is an essential component of imaging interpretation.
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