digestive disorders
Acute Pancreatitis
Diagnosis of Acute Pancreatitis
Blood tests Imaging tests Characteristic abdominal pain leads a doctor to suspect acute pancreatitis, especially in a person who has gallbladder disease or who drinks a lot of alcohol. During the examination, a doctor often notes that the abdomen is tender and the abdominal wall muscles occasionally are rigid. When listening to the abdomen with a stethoscope, a doctor may hear few or no bowel (intestinal) sounds. No single blood test proves the diagnosis of acute pancreatitis, but certain tests suggest it. Blood levels of two enzymes produced by the pancreas—amylase and lipase—usually increase on the first day of the illness but return to normal in 3 to 7 days. If the person has had other flare-ups (bouts or attacks) of pancreatitis, however, the levels of these enzymes may not increase significantly, because so much of the pancreas may have been destroyed that too few cells are left to release the enzymes. X-rays of the abdomen may show dilated loops of intestine or, rarely, one or more gallstones. Chest x-rays may reveal areas of collapsed lung tissue or an accumulation of fluid in the chest cavity. An Ultrasound Scanning (Ultrasonography) of the Abdomen of the abdomen may show gallstones in the gallbladder or sometimes in the common bile duct and also may detect swelling of the pancreas. This test is done in all people who are having a first attack of acute pancreatitis to make sure there are no gallstones present that might cause further pancreatitis. A Computed Tomography (CT) (CT) scan is particularly useful in detecting inflammation of the pancreas and is used in people with severe acute pancreatitis. For this scan, people are also injected with a contrast agent. The agent is a substance that can be seen on x-rays. Because the images are so clear, a CT scan helps a doctor make a precise diagnosis and identify complications of pancreatitis. Magnetic Resonance Imaging (MRCP), a special magnetic resonance imaging (MRI) test, may also be done to show the pancreatic duct and bile duct and to determine if there is any dilation, blockage, or narrowing of the ducts. Endoscopic Retrograde Cholangiopancreatography allows doctors to view the bile duct and pancreatic duct. During this test, doctors are able to remove from the bile duct gallstones that are causing a blockage. In endoscopic retrograde cholangiopancreatography (ERCP), a radiopaque dye is introduced through an endoscope (a flexible viewing tube), which is inserted into the mouth and through the stomach into the duodenum (the first segment of the small intestine). The radiopaque dye is injected into the biliary tract just past the sphincter of Oddi. The dye then flows back up the biliary tract and often shows the pancreatic ducts. Surgical instruments can also be used with the endoscope, allowing a doctor to remove a stone in a bile duct or insert a tube (stent) to bypass a bile duct blocked by scarring or cancer. If doctors suspect that there is an infection, they may withdraw a sample of infected material from the pancreas by inserting a needle through the skin into the fluid collection. Urine may also be tested for an enzyme called trypsinogen. This enzyme is secreted by the pancreas. If the level of this enzyme is elevated in the urine, the person may have pancreatitis. 