Studies of Pancreatic Structure and Function



The pancreas until recently was frustratingly difficult to study in the presence of suspected dis­ease. It can now be successfully imaged nonin-vasively by ultrasonography and computed tom­ography (CT) (Fig. 42-3) and invasively by endoscopic retrograde cholangiopancreatography (ERCP). Biopsy by fine needle with ultrasound or CT guidance and selective angiography are also useful in selected cases, and imaging by nuclear magnetic resonance (MRI) may prove useful in the future.

Acute injury to the pancreatic acini is reflected by leakage of the enzyme amylase into blood, which can be measured as an increase in serum amylase or more rarely as urinary amylase. Nor­mal serum amylase (25 to 125 U/L) largely origi­nates in salivary glands. Pancreatic secretion is estimated, with considerable error, by aspiration of duodenal contents through a tube following stimulation with secretin, secretinCCK, or a test meal, as summarized in . Such quan­titative studies of secretion are rarely clinically indicated.