The pancreas clinic

Patients who are seen in the Day Case Clinic receive a comprehensive assessment by a dedicated multi-disciplinary team with a broad experience in all the pancreatic disorders. Here are outlined the consultations and the examinations included in the “pancreatic disease diagnostic pathway” of the Verona University Hospital Trust. 

 

Specialistic consultations                

  • Follow-up consultation (Surgery)           
  • Oncology consultation
  • Gastroenterology consultation                                  
  • Diabetes consultation                               
  • Endocrinology consultation                           
  • Pathology consultation (slides review)                       
 

Radiology, interventional radiology, and nuclear medicine tests                              

  • Pancreas-directed contrast-enhanced ultrasound                           
  • Contrast-enhanced computed tomography (CT scan)                            
  • Gadolinium-enhanced Magnetic Resonance Imaging (MRI), Magnetic Resonance Cholangio-Pancreatography (MRCP)   
  • Secretin-Enhanced Magnetic Resonance Imaging (MRI)
  • 18-Fuorodesoxyglucose Positron-Emission Tomography (PET)
  • 68-Gallium Positron-Emission Tomography (PET)    
  • Endoscopic Retrograde Colangio-Pancreatography (ERCP)                           
  • Percutaneous Ultrasound-Guided or CT-guided Fine Needle Biopsy                                          
  • Percutaneous Transhepatic Biliary Drainage (PTBD)                                     
  • Endoscopic Ultrasound (EUS) with needle biopsy/cyst fluid sampling                        
  • Fistulography                                          

 

Laboratory tests                             

  • Routine blood tests (blood count, renal function, liver function, proteins, pancreatic amylase and lipase)
  • Glycosylated Hemoglobin (HbA1C)
  • Serum Tumor Markers (Ca-19-9, CEA, Ca 125, Ca 15.3, Chromogranin A, Neuron-Specific Enolase)
  • Cyst fluid CEA
  • Serum serotonin
  • Serum Insulin and C-Peptide
  • Serum Gastrin
  • Serum Glucagon
  • Urinary 5-hydroxyindolacetic acid (5-HIAA)
  • Anti-SPINK1 antibodies 

 

Pre-operative assessment clinic

Patients candidate to pancreatic surgery will attend the Pre-Operative Assessment Clinic, where certain tests are taken. Routine pre-operative tests include blood count, coagulation, renal and liver function, protein assessment, tumor markers (if needed), urine dipstick, electrocardiography, and chest x-ray. Furthermore, patients will be seen by the anesthesiologist, who reviews the medical history and may request further examinations on the basis of the estimated operative risk.

In patients with comorbidities or reduced organ function (especially cardiovascular and respiratory), it may be necessary to perform additional tests to evaluate the functional reserve and estimate the operative risk more precisely. These may include ecocardiography, test for exercise-induced ischemia, lung function tests, or other specialistic consultations. When the pre-operative diagnostic pathway is completed, the case is discussed with the attending surgeon and with anesthesiologists, and the patient is scheduled for surgery.