How to examine the pancreas

Diseases of the pancreas( pancreatitis, neoplasms, cysts, stones in the ducts) are accompanied by a violation of the general process of digestion. And the induced change in the synthesis of hormones( insulin and glucagon) that regulate blood glucose levels affects the metabolism of the whole organism. Therefore, it is important to use the diagnostic capabilities of pancreatic pathology to help and prevent dangerous consequences.

We will look at how to check the pancreas by available methods. How useful it is to use the entire volume of diagnostics depends on the patient's condition, the possibilities of the nearest medical institution.

We warn the reader that the specific choice of method or necessary tests for the examination of the pancreas remains with the doctor. The same applies to the interpretation of results and conclusions.

Working with the patient

People who underestimate the finding of complaints of a sick person and the importance of personal examination of a doctor are very mistaken. Of course, every person describes their feelings as they can, but the information obtained is no less valuable for diagnosis than instrumental research.

Patient questioning results

The main complaints indicating pancreatic pathology are:

• abdominal pain;
• dyspeptic phenomena( nausea, loose stool, bloating, vomiting);
• skin yellowness;
• general weakness;
• significant weight loss.

The characterization of the pain syndrome is described quite clearly by the patient:

• , short-term cramping pains are possible 3-4 hours after eating fatty foods or prolonged intense, lasting several days;
• is often poorly treated with antispasmodic agents;
• localization - the zone of epigastrium or the left hypochondrium, irradiate in the back, capture the entire upper abdomen, patients emphasize the "shingles" character.

Sudden and very intense pain is characteristic of acute pancreatitis. They are caused by a blockage of the main excretory duct of the gland due to inflammation and edema of the surrounding tissue.

In the mechanism of pain, the role of the redistribution of the solar plexus plays the role

. The tumor has a value of constant, strengthening in the position on the back. If the cancer of the gland is suspected, the patient describes the pain in the hypochondrium to the right with spreading to the back, body and tail - pains in the epigastrium, left hypochondrium, "surrounding" the character. Prolonged aching pain is possible with chronic pancreatitis. When finding out what helps during an attack, the patient shows a typical semi-bent posture.

Patients complain:

• for poor appetite;
• aversion to food, especially greasy;
• persistent nausea;
• bloating;
• diarrhea with the allocation of feces covered with a shiny coating( "fatty stool"), with a fetid odor.

Jaundice of the skin has a brownish or greenish tint, accompanied by severe itching of the skin, hemorrhages( bruises).If the patient complains about such signs, then it is possible to diagnose a tumor in the head of the pancreas or the effects of chronic pancreatitis( organ sclerosis) without blood tests.

Symptom is caused by compression of the common bile duct that leaves the liver. There is a situation where the liver and gallbladder need to be inspected to check the pancreas. Diagnosis of pancreatic diseases involves finding out the factors that contribute to the onset of pathology.

The patient is always asked:

• on diet and fattening;
• drinking alcohol;
• the presence in the history of the disease of chronic cholecystitis;
• hereditary predisposition to tumor growth.

Evaluation of the results of the

inspection The examination of the patient, with skillful conduct, gives the necessary data for the diagnosis. Acute pancreatitis is characterized by pale skin with areas of cyanosis( consequences of intoxication and damage to capillaries).

In cancer, the patient is depleted, the skin is yellowed, dry with traces of scratching and hemorrhages. Often marked abdominal swelling, bloating. It is very difficult to palpate a painful abdomen. The muscles of the abdominal press are strained. The maximum soreness is observed in epigastrium, less often in the hypochondrium on the left.

To probe the increased gland it is possible only in 4-5% of cases at women's patients, in 1-2% of men. Instead of an even horizontal cylindrical formation, a dense, hummocky cord is defined. With palpation, you can mistakenly take part of the neighboring organs for the pancreas:

• stomach;
• transverse colon;
• enlarged lymph nodes.

The peculiarity of the body requires consideration of both the exocrine and hormonal functions of

. Which studies are included in the diagnostic scheme?

If a doctor diagnoses a pancreas that is suspicious of a pancreas disease, during a questioning and examination, he or she appoints a full examination of the pancreas. For this, the following are used:

• blood test for biochemical tests;
• biochemical examination of urine, revealing the level of diastase;
• feces analysis for scatology to identify undigested food residues, fats( steatorrhea);
• ultrasound helps in detecting sizes, shapes, tumors and cysts;
• diagnostic tests provide information on the impaired functional abilities of the organ;
• as additional sources in the search for indirect signs use X-ray, magnetic resonance imaging( MRI) and computed tomography of the pancreas, neighboring organs;
• tissue biopsy.

The importance of biochemical tests of blood and urine on enzymes

Methods for examining the pancreas usually begin with the simplest laboratory tests. The essence of their results is the detection of an elevated level of specific enzymes in the blood and urine that have entered the unusual environment due to an abnormal outflow of secretion into the duodenum.

On the pathology of the pancreas indicates an increase in the concentration of enzymes:

• lipase,
• amylase,
• trypsin.

Amylase normally enters the blood in a small amount from the salivary glands. In 78% of patients with pancreatitis, the level of amylase is increased 2 or more times. Biochemical methods of detection of amylase are based on the reaction of starch digestion. Use the methods of Wolgemut, Smith-Roy.

The result of the determination of amylase is the electrophotocolorimetry of the colored compound

. The lipase is determined by the method of stargomometry. It shows the change in the surface tension formed by the action of lipase from fatty acids in a sensitive solution of tributyrin. The blood contains several varieties of lipases. In the diagnosis of the pancreas, the ethoxyl resistant species is most important, it is increased in 90% of patients.

It is important to evaluate both results, if amylase is increased, and lipase is at a normal level, you need to think about another pathology. A blood test is done on an empty stomach. Urine should be collected in a clean container. Special training is not required. If necessary, make an analysis for examining the pancreas for emergency indications at any time of the day.

The endocrine function of the gland to maintain optimal blood glucose levels with insulin and glucagon is worth checking for all patients, as experience shows that it is impaired in 75% of patients with pancreatitis and tumors.

How is feces performed?

In the presence of a liquid stool, a feces analysis for coprology is prescribed. Both macroscopic signs( consistency, smell, color) and a smear under a microscope are examined. You can identify the effects of impaired digestion: undigested muscle fibers( from meat), neutral fat.

If a pancreas pathology is suspected, the examination should be determined by steatorrhea. Quantitatively revealed from the contents of the intestine to 15 grams of fat per day, although in the norm it contains only 6 g( 94% absorbed).In feces with chronic pancreatitis, a decrease in chymotrypsin activity is detected.

Ultrasound

Ultrasound has found wide application in practical public health. It is especially important for the possibility of testing the pancreas without any analysis with a deep arrangement of the organ.

The complexity of ultrasound is due to individual features of the location and size of the gland, the presence of gases in the intestine. Therefore, 10% of the subjects can not determine the organ. Especially it concerns patients with excess weight. The method in 80% confirms the presence and localization of the tumor, almost 100% diagnoses cysts, if they are larger than 15 mm in size.

How are diagnostic tests performed?

Investigation of the pancreas, if necessary, can be supplemented with diagnostic tests to detect non-hormonal functions of the body( exocrine).All methods divide:

• for requiring the use of an intestinal probe;
• non-invasive( bezsonde).

The lack of tests - the emergence of results only with a significant reduction in the secretion capacity of the pancreas, so they are considered to be insensitive

In practice, the following tests are used:

• pancreosimine-secretin;
• test of Lund;
• hydrochloric acid;
• is elastase.

Pancreosimine-secretin test

To the patient on an empty stomach, insert the probe into the duodenum with two holes. Aspiration of gastric and duodenal secretions is performed in stages. Then, intravenously, secretin and pancreosimine are administered. After the injection, new samples are taken to study the concentration of bicarbonates, the activity of trypsin. The rate of secretion is calculated.

Pancreatitis is characterized by a decrease in secretion, a decrease in the level of bicarbonates, an increase in the concentration of enzymes. It is possible to identify false positive data in patients with diabetes mellitus, dysfunction of the bile duct, hepatitis and cirrhosis of the liver.

The Lund test

differs by using a standard food mixture as a food irritant of the gland. In the morning the patient is injected with a probe into the duodenum with an attached weight at the end, through it - a food mixture( vegetable oil, dried milk with dextrose).Aspirates of the samples are collected for two hours. Then, the level of amylase is determined therein. The variant is more simple and cheaper, it is not connected with injections.

Hydrochloride test

From the previous differs kind of applied stimulus - a solution of hydrochloric acid 0,5% in olive oil. The further actions are the same. Disadvantages are common.

Elastaznyj test

It is based on research of elastase of a feces of the patient. Gives a positive result for chronic pancreatitis, biliary diseases, gallstones, diabetes mellitus.

X-ray signs of

It is possible to detect indirect signs or consequences of pancreatic damage on the chest radiograph. These include:

• a rare detection of stones or lime salts in the pancreatic ducts at the level of the upper lumbar vertebrae( a sign of chronic pancreatitis);
• large cyst in the form of a uniform formation with clear boundaries;
• deformation and bias displacement of the duodenum with an enlarged pancreas head;
• defects of filling on the back wall or large curvature of the stomach with a tumor( cyst) in the body or tail area.

X-ray is not a very suitable method for examining the gland

A more targeted study is retrograde pancreatography, virsungography. Contrast must be introduced directly into the pancreatic duct. Then take pictures, which reveal its expansion or sharp narrowing to a complete breakage( stone).Angiography is a significant complication. With it, contrast material is injected through the catheter into the aorta and the celiac artery through the femoral approach.

Radioisotope methods

Radioisotope diagnosis consists of intravenous administration of a related labeled substance with a predominant absorption of the pancreas. A special drug methionine labeled with isotope selenium is used.

Scanning starts after half an hour. The rapidity of isotope accumulation in the gland and passage into the intestine is taken into account. If the cells of the gland are affected, then the absorption is slow, a spotty scan pattern appears.

What does tissue biopsy do?

The method of biopsy means sampling a pancreatic tissue sample for histological examination. This is an infrequent procedure. It is carried out in extreme cases to exclude cancer, in differential diagnosis.

May be an independent study or part of a surgical procedure. Special equipment, needles are needed for the conduct. The tool has the form of a pistol with a knife end for cutting tissue.

The biopsy is performed under the control of a computer tomography with local anesthesia, with a small amount of a suspected tumor, it is difficult to get into it

The laparoscopic method under anesthesia introduces a thin endoscope into the abdominal cavity, examines it for metastases, infiltrate size for inflammation, effusion to the peritoneum. A special sample is taken from the tissue sample. During the operation, the extraction of material from the gland's head is possible with a needle through the duodenum.

Further histological examination allows to confirm or reject the assumption of malignant lesion, shows the degree of inflammatory reaction, replacement of functioning tissue with scars. To examine such a complex organ as the pancreas, one method is not enough. The doctor needs the results of a comprehensive study, own examination and analysis of complaints.