GASTROENTEROLOGY ARTICLE OF THE WEEK
February 22, 2007
Findelberg DL, Sahani D, Deshpande V, Brugge WR. Autoimmune pancreatitis. N Engl J Med 2006;355:2670-6.
1. Findings in autoimmune pancreatitis that support the presence of an autoimmune process include
a. Predominance in females
b. Association with rheumatoid arthritis, Sjogren’s syndrome and IBD
c. The presence of increased gamma globulins, particularly IgG4 levels
d. Lactoferrin antibodies
e. Carbonic anhydrase antibodies
2. Extra-pancreatic features that may be seen with autoimmune pancreatitis include
a. Renal insufficiency
b. Pulmonary nodules
c. Short band-like strictures of the bile ducts causing a beaded appearance
d. Low attenuation lesions in the renal parenchyma seen on CT scan
e. Mediastinal adenopathy
True or False
3. Histologically, autoimmune pancreatitis is characterized by intense inflammatory infiltrate in the absence of fibrosis
4. Jaundice is more common than abdominal pain as the presenting symptom in autoimmune pancreatitis.
5. The histologic findings of autoimmune pancreatitis are restricted to the pancreas and do not involved any other organs
6. Typical patients with autoimmune pancreatitis are females over age 50.
7. Long segmental bile duct strictures in a patient with IBD favor autoimmune pancreatitis rather than sclerosing cholangitis as the most likely diagnosis.
8. The classical presentation of a patient with autoimmune pancreatitis is sudden onset of severe abdominal pain associated with marked elevations of amylase and lipase.
9. The presence of a pancreatic mass lesion on imaging studies excludes autoimmune pancreatitis
10. The classic finding of autoimmune pancreatitis on ERCP is a focal, diffuse or segmental attenuation of the main pancreatic duct and disappearance of right-angled branches.
11. Pancreatic inflammation improves with corticosteroids, pancreatic strictures do not change
12. The histologic hallmark of autoimmune pancreatitis is a collar-like periductal infiltrate composed of lymphocytes and plasma cells
13. The differentiation of strictured bile duct secondary to PSC vs. autoimmune pancreatitis is not clinically important as both are managed the same way
14. Untreated, autoimmune pancreatitis is invariably a progressive disease
15. EUS in autoimmune pancreatitis shows a diffusely hypoechoic parenchyma, pancreatic biopsy is the gold standard for diagnosis
16. The typical findings on abdominal CT in a patient with autoimmune pancreatitis include a diffusely involved pancreas with homogenous attenuation and a peripheral rim of hypoattenuation or “halo”
17. The recommended treatment of autoimmune pancreatitis is prednisone 40mg daily for 6 to 12 months.