How to diagnose pancreatitis

Patient with pancreatic inflammation( pancreatitis) most often causes "First Aid" because of severe pain. The disease occurs in acute or chronic form. To diagnose pancreatitis, it is not enough to see a doctor.

In addition to the characteristic symptomatology, it is based on the results of a survey, which allows to judge the extent of the organ organ dysfunction. Only an integrated approach to the detection of pathology allows you to choose the optimal treatment for the patient.

How is pancreatitis diagnosed?

Signs of pancreatitis are most often manifested after an overload of the pancreas with abundant fatty and meat foods, spicy dishes, alcoholic beverages. As a rule, pancreatitis in adults is accompanied or preceded by problems with bile secretion caused by cholelithiasis, cholecystitis, dyskinesia of the bile ducts. The connection is explained by the anatomical location of a single outlet hole in the duodenum. Symptoms of acute and chronic illness differ in intensity.

Acute manifestations of

In acute pancreatitis or during an exacerbation of chronic, the main signs of inflammation are:

• Intensive pain in the epigastric region with irradiation in the back, along the lower ribs, into the scapula, thorax. The pains are permanent, they are not relieved by anesthetics and antispasmodics. Patients are excited, shouting, in case of severe current, a shock with loss of consciousness is possible.
• Vomiting is repeated and painful, does not give relief to the patient, increases weakness.
• Bloating, difficulty in removing gases, stools.
• Patients have a characteristic appearance: sunken eyes, pale face, cyanotic lips, blue-red spots on the skin of the buttocks are possible.
• A rise in temperature indicates an infected form of acute pancreatitis. It usually keeps at a level of 38 degrees, against this background, a weak pulse is detected, a pronounced tachycardia. Sharp "jumps" and a drop in temperature indicate a purulent infection in neighboring tissues, peritonitis.
• Patients have a tendency to fluctuate blood pressure.

Hospital wardens on duty usually expect patients to arrive in the evening and at night on public holidays

Symptoms of chronic form

The chronic course of the disease causes digestive disorders. It reflects the defeat of pancreatic function and manifests itself:

• typical diarrhea, in which the weight of stool is increased, it is covered with a film of undigested fat, has a gray color and fetid odor;
• by weight loss;
• abdominal pain that occurs intermittently after a diet violation, do not have a clear localization, can be shrouded in nature, some patients do not;
• with occasional nausea, with a single vomiting.

Chronicle patients may have signs of endocrine gland failure( blood glucose fluctuation), so there is a shiver in the body, dizziness, hunger and thirst, cramps in the muscles of the limbs. Symptomatic pancreatitis is very similar to other diseases of the abdominal cavity.

It is necessary to diagnose pancreatitis as early as possible, as the course progressively worsens the condition of the pancreas, leads to widespread necrosis and melting of tissues, damage to other organs. Differential diagnosis requires knowledge of the distinctive features of diseases with a similar clinical course.

The proximity of the pancreas to other organs and the solar plexus creates the effect of shingles in inflammation

Laboratory diagnosis of pancreatitis

You must always carefully and with understanding to treat the doctor's request to take tests. Only laboratory indicators give a complete picture of the diagnosis, reveal the degree of disruption of the pancreas, the phase of inflammation. Analyzes for chronic pancreatitis are not as revealing as in the acute stage. The most informative are:

Among the blood tests:

• leukocytosis with a left shift, significant acceleration of ESR( shows the severity of inflammation), the presence of eosinophilia binds pancreatitis to the autoimmune mechanism of development, anemia( decrease in the number of red blood cells and hemoglobin) is present in patients with chronic form;
• biochemical tests for the increased activity of amylase( isomer P-isoamylase) and lipase, aminotransferases, alkaline phosphatase, many times over the norm indicate the release of enzymes into the blood, intoxication of the body, the growth of bilirubin confirms the association of pancreatitis with stone overlap or edema of the bile duct;
• it is believed that to reduce the calcium content can be judged on the severity of the disease;
• for the study of the endocrine function to determine the glucose in the blood and urine, acetone, ketone bodies, it may be necessary to carry out a stress test, in patients with chronic pancreatitis it is not excluded the development of diabetes mellitus;
• in chronic pancreatitis decreases the blood protein( due to albumins), cholesterol and triglycerides grow.

In urinalysis, proteinuria( the appearance of a protein in the urine) is important, an increase in the number of cylinders, red blood cells, which reflects general circulatory disorders, hypoxia of the kidney tissues. The growth of diastase in the daily urine is proportional to the level of amylase in the blood. Urobilin allows you to judge the increase in jaundice. In the coprogram there is an increased amount of fat, undigested fibers, food particles.

According to the analysis of stool, it is possible to recognize a characteristic violation of fat digestion in the chronic form of pancreatitis. Determine what tests are best to pass for pancreatitis can only a doctor. You can not try to decipher the results yourself. They are important only in conjunction with clinical manifestations and data of instrumental research.

What tests determine the function of the pancreas?

The activity of the inflammatory process in pancreatitis is diagnosed not only by laboratory tests, but also by functional tests. Probe tests are considered to be the most accurate. They are obtained by receiving a gastroduodenal probe( direct method) by aspirating the contents of the duodenum and determining in it the enzymes of the pancreas and bicarbonate salts.

The secretinpine-resozymin test is considered the most informative. Indirect methods( the Lund test) study the effect of the nutritional load. No-probe tests - give less accurate information. Direct is the determination of the content of enzymes in the feces( chymotrypsin, elastase).

Indirect methods are based on calculating the amount of digestion of food, isolated fat, by coprologic examination. Similar tests are carried out on a daily urine( pancreolauril, Shilling), on exhaled air( triglyceride, protein, amylase).

Instrumental methods

Current opinions of doctors on the diagnosis of pancreatitis require that laboratory indicators should be supplemented by the results of possible instrumental studies. Not all medical institutions have expensive equipment, but the minimum volume with the help of radiographs, ultrasound apparatus can perform at the level of the district hospital.

What does radiography provide?

In the image of the abdominal cavity the swollen portion of the transverse colon is revealed, against the background of pancreatonecrosis, the formation of gas in the loops of the small and large intestine is significantly increased. Possible detection of stones in the gallbladder or duct. With chronic pancreatitis, calcifications( deposits of calcium salts) in the pancreas are often seen.

When looking at the chest, there are indirect signs caused by the effects of pancreatitis: fluid in the left pleural cavity( rarely on both sides), compression of the lower lobe of the lung, limited motility of the diaphragm. More specific information is obtained by X-ray examination of the stomach, duodenum with contrasting barium mixture, with cholecystography.

On ultrasound in chronic pancreatitis, calcification is detected in the bile ducts and parenchyma of the gland

Ultrasound diagnostic capabilities of

The conclusion of ultrasound in pancreatitis is based on the detection of:

• organ enlargement;
• of an even line of contours at the stage of edema and blur if the inflammation passes to the pancreatic cellulose tissue;
• properties of echogenicity of the parenchyma are higher in the stage of remission, falling at exacerbation, with pancreanecrosis of the most pronounced heterogeneity;
• of the modified organ structure, which shows pseudocysts, areas of expansion of the central duct.

Additional signs are:

• squeezing of large veins of the abdominal cavity;
• fluid in the abdomen;
• increase in the diameter of the common bile duct;
• splenomegaly;
• large lymph nodes in the near-pancreatic fat.

With prolonged chronic pancreatitis, the pancreas becomes uniformly dense, reduced by fibrosis. Ultrasound in the Doppler mode reveals differences in cancer and pancreatitis, determines the altered blood supply to the vascular pattern. The doctor-diagnostician studies all changes taking into account age features.

For more thorough research in specialized clinics, methods of intraprostatic ultrasound( conclusion about the tone, patency of the bile ducts), ultrasound guided percutaneous pancreatography, laparoscopic echography are used.

What does computer and magnetic resonance imaging show?

These methods most clearly diagnose the spread of inflammation from the pancreas to the abdominal cavity organs, retroperitoneal space, lymph nodes. Fixed clearer than with ultrasound disorders due to edema of the parenchyma, even a small increase in the size and infiltration of the pancreas, the surrounding space, pseudocysts, deformation of the main duct, calcinates.

Magnetoresonance studies are not hampered by increased gas formation in intestinal loops

Endoscopic methods

With the help of endoscopic retrograde cholangiopancreatography, cystic lesions in the gland, deformation of the central duct in a certain part of the organ( rarely in the tail) are revealed. Laparoscopy( examination of the abdominal cavity through a small incision) allows you to notice the external changes in the organs( steatonecrocaltic fatty plaques on the mesentery and intestines), take for analysis the fluid from the abdominal cavity, the biomaterial from specific sections of the gland.

What diseases are used for differential diagnosis?

Clinical manifestations of the "acute abdomen" - a common symptom of various diseases, not only surgical, but also therapeutic profile. Most often it is necessary to differentiate pancreatitis in acute form.

Myocardial infarction

The disease is caused by coronary artery thrombosis. The pain is more often localized behind the sternum, have a pressing, "burning" character. Not associated with overeating, cholelithiasis. Gastralgichesky variant can not be distinguished from inflammation of the pancreas.

But additional tests for pancreatitis will show high leukocytosis, ESR, the growth of pancreatic enzymes. For the damage of the myocardium, the increase of aspartic transaminase, lactate dehydrogenase, and creatine phosphokinase is more typical. There are no changes in urine and feces. The results of the ECG help verify the diagnosis.

Perforating ulcer

The perforation of the stomach ulcer is accompanied by "dagger pain".When examined, signs of peritonitis immediately appear. Vomiting is not typical. Patients are usually afraid to move. A free-gas in the cavity of the peritoneum is revealed on the survey radiograph.

Acute cholecystitis

The disease gives intense pain in the hypochondrium to the right, radiating to the right collarbone, shoulder, scapula. Accompanied by nausea, vomiting with bitterness.

Intestinal obstruction

Doubts can cause bloating and non-occurrence of gases. Pain has a pronounced cramping character with periods of weakness. Inflammation is determined above the site of obstruction.

Mesenteric artery thrombosis

Mesothrombosis is typical for elderly patients with long-term cardiovascular disease. Pain in the abdomen is not associated with eating or eating a diet.

Pancreatic cancer

Helps distinguish from pancreatitis the definition of oncomarkers( cancer-embryonic antigen and carbobutyric antigen).They are slightly elevated in pancreatitis, and with cancer dozens of times.

Methods of examination in pancreatitis are important not only for the correct diagnosis, but also in evaluating therapeutic measures, choosing indications for surgical treatment. Clinical follow-up at a gastroenterologist requires a routine check of the pancreas in chronic conditions.