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Diagnosis of pancreatitis can be made very early
in the disease by noting high levels of pancreatic enzymes
circulating in the blood (amylase and lipase). Later in the disease,
and in chronic pancreatitis, these enzyme levels will no longer be
elevated. Because of this fact, and because increased amylase and
lipase can also occur in other diseases, the discovery of such
elevations are helpful but not mandatory in the diagnosis of
pancreatitis. Other abnormalities in the blood may also point to
pancreatitis, including increased white blood cells (occurring with
inflammation and/or infection), changes due to dehydration from
fluid loss, and abnormalities in the blood concentration of calcium,
magnesium, sodium, potassium, bicarbonate, and sugars.
X rays or ultrasound examination of the abdomen
may reveal gallstones, perhaps responsible for blocking the
pancreatic duct. The gastrointestinal tract will show signs of
inactivity (ileus) due to the presence of pancreatitis. Chest x rays
may reveal abnormalities due to air trapping from shallow breathing,
or due to lung complications from the circulating pancreatic enzyme
irritants. Computed tomography scans (CT scans) of the abdomen may
reveal the inflammation and fluid accumulation of pancreatitis, and
may also be useful when complications like an abscess or a
pseudocyst are suspected.
In the case of chronic pancreatitis, a number of
blood tests will reveal the loss of pancreatic function that occurs
over time. Blood sugar (glucose) levels will rise, eventually
reaching the levels present in diabetes. The levels of various
pancreatic enzymes will fall, as the organ is increasingly destroyed
and replaced by non-functioning scar tissue. Calcification of the
pancreas can also be seen on x rays. Endoscopic retrograde
cholangiopancreatography (ERCP) may be used to diagnose chronic
pancreatitis in severe cases. In this procedure, the doctor uses a
medical instrument fitted with a fiber-optic camera to inspect the
pancreas. A magnified image of the area is shown on a television
screen viewed by the doctor. Many endoscopes also allow the doctor
to retrieve a small sample (biopsy) of pancreatic tissue to examine
under a microscope. A contrast product may also be used for
radiographic examination of the area. |
