Detailed laboratory examination of the pancreas

Forms of pancreatitis

Acute – characterized by acute girdling pain in the upper abdomen. Pain often appears after eating fatty foods or alcohol. Unpleasant sensations can be either barely noticeable or unbearable, radiating to the scapula or sternum. Nausea, vomiting, and stool disturbances are observed. Due to the obstructed flow of bile, the skin takes on a yellowish color.

Chronic - the main localization of pain is on the upper part of the abdominal wall with irradiation to the back, chest (left side), lower abdomen. Unpleasant sensations occur after eating heavy fatty foods, alcoholic drinks, and constant stress.

The development of chronic pancreatitis is characterized by nausea, loss of appetite, bloating, bowel dysfunction, and sometimes vomiting.

The chronic form of the pathology differs from the acute form by periods of remission and exacerbation. As the disease progresses, periods of exacerbation become more frequent; intestinal disorders, disturbances in normal digestion, and weight loss are possible.

Chronic pancreatitis often causes complications (stomach bleeding, cancer, cysts and abscesses, liver damage, diabetes mellitus, enterocolitis). That is why you need to take the disease seriously and, at the slightest suspicion of the development of inflammation, consult a doctor.

Normal size of the pancreas on MRI

Organ parameters are variable:

The concept of normal on magnetic resonance images is relative. Sizes depend on gender, height, age, food load. A slight deviation from generally accepted indicators, provided the structure of the organ parenchyma is normal and functions are intact, is not considered a pathology. The length of the pancreas is 15-23 cm, width 4.5-6 cm, weight about 70-80 grams.

Normally, the organ is not enlarged, the contours are clear, even, and the dimensions correspond to the person’s build. The pancreatic duct is not dilated, the surrounding tissue is without any features. No changes in the MR signal were detected.

Reasons for the development of pancreatitis

The disease develops due to damage to pancreatic tissue. This happens for the following reasons:

• alcohol and tobacco abuse
• abdominal trauma, surgery
• uncontrolled and long-term use of medications: antibiotics, hormonal drugs, corticosteroids, some diuretics
• intoxication with food products, chemicals
• genetic predisposition
• improper diet with a predominance of spicy and fatty foods and long breaks between meals

Ultrasound capabilities

Ultrasound examination has found wide application in practical healthcare. It is especially significant with the ability to check the pancreas without any tests when the organ is located deep.

The complexity of ultrasound is due to the individual characteristics of the location and size of the gland, the presence of gases in the intestines. Therefore, in 10% of subjects it is not possible to identify the organ. This is especially true for overweight patients. The method confirms the presence and location of the tumor in 80% of cases, and diagnoses cysts in almost 100% of cases if they are more than 15 mm in size.

[node:field_field_doprekl2]

Symptoms of pancreatitis

Manifestations of pathology vary depending on the form - acute or chronic pancreatitis. In acute pancreatitis the following are observed:

• The pain is intense, constant, the nature of the pain is described by patients as cutting, dull.
• High body temperature, high or low blood pressure - the patient’s well-being quickly deteriorates due to the rapid development of the inflammatory process.
• Pale or yellowish complexion.
• Nausea and vomiting - dry mouth and a white coating appear, attacks of vomiting do not bring relief. The most correct step at this moment is to fast; any food intake can only worsen the situation.
• Diarrhea or constipation - stool in acute pancreatitis is most often foamy, often with a foul odor, with particles of undigested food. On the contrary, there are constipation, bloating, and hardening of the abdominal muscles, which may be the very first signal of an acute attack of pancreatitis.
• Bloating – the stomach and intestines do not contract during an attack.
• Shortness of breath - appears due to loss of electrolytes during vomiting.

Chronic pancreatitis is characterized by the following symptoms:

• Abdominal pain - may be girdling or have a clear localization radiating to the back. Appears after eating.
• Intoxication of the body - general weakness, loss of appetite, tachycardia, increased body temperature, and decreased blood pressure appear.
• Endocrine disorders - ketoacidosis, diabetes mellitus, tendency to hypoglycemia. Bright red spots may also appear in the abdomen, back, and chest, which do not disappear with pressure.

With a long course of the disease, the patient gradually develops anemia, weight loss, dry skin, brittle hair and nails, symptoms of vitamin deficiency, and increased fatigue.

First aid for an attack of pancreatitis

To reduce pain, you can use a heating pad filled with cold water. It needs to be applied to the abdominal area, namely to the epigastric region (the area under the xiphoid process, corresponding to the projection of the stomach onto the anterior abdominal wall). This allows you to reduce the intensity of pain, slightly reduce swelling and inflammation.

The patient must comply with the hospital regime. This will reduce blood flow to the organ, and therefore reduce inflammation.

Eating is prohibited. The digestion process can cause more severe pain, nausea and vomiting. And the diet will reduce the production of enzymes that increase the inflammatory response and pain. You need to fast for 3 days. You can drink clean water without gases.

It is imperative to call a doctor for an examination, even if the patient is not exactly sure that this is an attack of acute pancreatitis. As we already know, this pathology can subside and then rapidly recur. At this time, you can take a painkiller to reduce discomfort.

Diagnosis of the disease at the private medical clinic “Medunion”

Diagnosing this disease is not difficult, since the first signs speak for themselves. However, in order to prescribe adequate treatment, it is necessary to determine the form of the disease. To do this, the doctor performs laparoscopy - a method that allows you to examine the abdominal cavity from the inside using a special instrument.

If acute pancreatitis is suspected, laboratory tests are performed:

• General blood analysis
• Blood chemistry
• Analysis of urine
• Stool analysis
• Ultrasound, MRI or radiography of the abdominal organs
• Computed tomography according to indications

In the chronic form, the same studies are carried out, but it is better to take tests during the period of exacerbation of the disease.

The importance of biochemical tests of blood and urine for enzymes

Methods for examining the pancreas usually begin with the most simple laboratory tests. The essence of their results is the identification of increased levels of specific enzymes in the blood and urine, which have entered an unusual environment due to impaired outflow of secretions into the duodenum.

[node:field_field_doprekl]

An increase in the concentration of enzymes indicates pancreatic pathology:

• lipases,
• amylase,
• trypsin.

The pancreas produces about 20 enzymes. But most often, patients are recommended to donate blood and urine for the first 2 types; trypsin is rarely tested.

Amylase normally enters the blood in small quantities from the salivary glands. In 78% of patients with pancreatitis, amylase levels are increased by 2 or more times. Biochemical methods for detecting amylase are based on the reaction of starch breakdown. Wolgemuth and Smith-Roy methods are used.

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

Lipase is determined by stalagmometry. It shows the change in surface tension generated by fatty acid lipase in a sensitive tributyrin solution. The blood contains several types of lipases. In the diagnosis of the pancreas, the ethoxyl-resistant type is of greatest importance; it is elevated in 90% of patients.

It is important to evaluate both results; if amylase is elevated and lipase is at normal levels, you need to think about another pathology. A blood test is taken on an empty stomach. Urine should be collected in a clean container. No special preparation is required. If necessary, an analysis is performed to examine the pancreas for emergency indications at any time of the day.

It makes sense to check the endocrine function of the gland to maintain optimal blood glucose levels with the help of insulin and glucagon in all patients, since experience shows that it is impaired in 75% of patients with pancreatitis and tumors.

The study is carried out using methods of determining blood glucose once on an empty stomach, testing for glucose tolerance with stress tests, and assessing glucosuria in 24-hour urine.

Treatment of acute pancreatitis

If acute pancreatitis is detected, the patient should be hospitalized immediately. Treatment should take place in a hospital setting, as this condition is very dangerous.

To relieve pain, antispasmodics are taken; in difficult cases, the contents of the stomach are pumped out to relieve the load on the gland.

In case of exacerbation of pancreatitis, patients require hospitalization with daily monitoring of blood parameters, water balance, leukocyte count, and enzyme levels in the blood serum during the first week. In the first 1–3 days, fasting and taking alkaline solutions every 2 hours are recommended.

During an exacerbation of chronic pancreatitis, the patient is shown therapy similar to the acute process. The patient must follow a diet throughout his life and take drugs from the group of antispasmodics and drugs that normalize the secretory function of the organ.

The most important thing in the chronic form of the disease is to maintain a diet that involves excluding fatty and fried foods from the diet. At the slightest violation of the regimen, the patient may experience discomfort and nausea. For intense pain, the doctor prescribes antispasmodics. Antisecretory therapy can be used for a short course.

How are diagnostic tests performed?

Examination of the pancreas, if necessary, can be supplemented with diagnostic tests to identify non-hormonal functions of the organ (exocrine). All methods are divided into:

• those requiring the use of an intestinal tube;
• non-invasive (probeless).

The advantage of tests (especially probeless ones) is convenience for the patient and low cost.

The disadvantage of the tests is that results appear only with a significant decrease in the secretory capacity of the pancreas, so they are considered insensitive

The following tests are used in practice:

• pancreozymin-secretin;
• Lund test;
• hydrochloric acid;
• elastase.

Pancreozymin-secretin test

For the patient on an empty stomach, a probe is inserted into the duodenum with two holes. Aspiration of gastric and duodenal secretions is carried out step by step. Then secretin and pancreozymin are administered intravenously. After the injection, new samples are taken to study the concentration of bicarbonates and trypsin activity. The rate of secretion is calculated.

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

Lund test

It is distinguished by the use of a standard food mixture as a food irritant to the gland. In the morning, the patient is inserted into the duodenum with a weight attached to the end, through which a food mixture (vegetable oil, milk powder with dextrose) is inserted. Sample aspirates are collected within two hours. Then the level of amylase in them is determined. The option is simpler and cheaper, and does not involve injections.

Hydrochloric acid test

It differs from the previous ones in the type of irritant used - a solution of 0.5% hydrochloric acid in olive oil. Further actions are the same. The disadvantages are general.

Elastase test

Based on the study of elastase in the patient’s stool. Gives a positive result for chronic pancreatitis, liver diseases, gallstones, diabetes.

Diet for pancreatitis

For any form of the disease, the patient is prescribed a strict diet “Table No. 5p”, according to which it is forbidden to eat spicy and fried foods. All dishes are steamed, boiled or baked. Alcohol and smoking are also prohibited.

It is also necessary to limit salt intake and eat small portions 6 times a day. Dishes should always be served warm. It is necessary to exclude all products with a high content of extractives or essential oils (fish, meat broths, cocoa, coffee, etc.), fresh berries, vegetables, herbs, fruits, sour juices, carbonated drinks, marinades.