Clinical Features. The main clinical symptoms that indicate disease of the pancreas are:
➤ pain
➤ cholestasis
➤ weight loss
➤ diabetes mellitus
➤ diarrhea/steatorrhea

Acute and chronic pancreatitis and pancreatic carcinoma are the most important diseases. Acute and chronic pancreatitis in the early stages generally have an identical clinical picture, characterized by one or more acute episodes of pancreatitis. The main difference is the long term course. In contrast to chronic (progressive) pancreatitis, acute (reversible) pancreatitis is cured after causal therapy (primarily cholelithiasis). Morphologically, scars and pseudocysts may persist after severe acute pancreatitis. Typical signs of chronic pancreatitis are irreversible exocrine and/or endocrine insufficiency, often combined with pancreatic calcifications, which on average occurs 5−6 years after onset of the disease. Approximately 50% of cases of nonalcoholic The diagnosis of diseases of the pancreas is based on medical history, clinical findings, imaging (abdominal radiograph, sonography, endosonography, CT, cholangio-MRI, ERCP), and laboratory tests, including various tests for evaluation of the exocrine pancreatic function. Unlike the parameters for hepatobiliary diseases , tests for diseases of the pancreas are much less informative for differential diagnosis. However, in most cases it is possible to interpret the laboratory results correctly in the context of the clinical and imaging findings.

Amylase. Elevated amylase levels in blood and urine indicate acute pancreatitis. An increase in enzyme activity to four or five times above normal with subsequent normalization is characteristic of acute pancreatitis. Elevated levels persist longer in urine (7−10 days) than in serum (1−5 days). Numerous extrapancreatic diseases may cause an increase in serum and urine amylase levels and must be considered in the differential diagnosis.

In macroamylasemia the amylase circulates as a macromolecular aggregate or as a complex with immunoglobulins, which are too large for renal excretion. This is usually a chance finding. The diagnosis is made chromatographically. Determination of lipase, trypsin, or pancreas isoamylase can increase diagnostic accuracy in selected cases. Low amylase and lipase values are found in acute pancreatitis if hypertriglyceridemia is present.

Exocrine Pancreatic Function. Chymotrypsin or elastase in the stool best reflects the exocrine function of the pancreas.
The tests are more complex and in some cases invasive, are only used in selected cases. The pancreozymin−secretin test has the greatest specificity and sensitivity. The test requires intubation of the duodenum and a radiologic confirmation of the posichronic pancreatitis are primarily painless and become symptomatic in general with weight loss due to diabetes mellitus or diarrhea/steatorrhea. The etiology is important for the prognosis. Biliary pancreatitis virtually never becomes chronic, while in alcohol uses chronic pancreatitis is common.