Pancreatitis

Diagnosis

Because diagnosing pancreatitis can be difficult, physicians are likely to conduct several tests to pinpoint the problem.

Tests for Acute Pancreatitis

If acute pancreatitis is suspected, a blood sample may be analyzed for abnormalities such as:

• Elevated levels of pancreatic enzymes, amylase and lipase
• Elevated white blood cell count
• Elevated liver enzymes and bilirubin, a substance resulting from breakdown of red blood cells
• High blood sugar (hyperglycemia)
• Low calcium levels — high calcium levels can cause pancreatitis, but low levels of calcium in the blood result from severe forms of pancreatitis

Because laboratory tests alone can't confirm a diagnosis of acute pancreatitis, a Mayo physician may request an ultrasound or computed tomography (CT) scan of the abdomen to examine the pancreas and check for gallstones, duct problems or gland destruction. Abdomen and chest X-rays are sometimes used to rule out other reasons for symptoms.

Tests for Chronic Pancreatitis

Diagnosing chronic pancreatitis is challenging because testing may yield normal results, even when the disease is present. However, certain tests can help rule out other problems and aid in the diagnosis. These include:

• Blood tests — They can identify abnormalities associated with chronic pancreatitis and help rule out acute inflammation.
• Stool test — This measures fat content in the feces. Chronic pancreatitis often causes excess fat in the stool because fat isn't digested and absorbed normally by the small intestine.
• Ultrasound — Endoscopic ultrasound may provide images of the pancreas and of bile and pancreatic ducts superior to those produced by standard ultrasound. Doctors thread a thin, flexible tube (endoscope) containing a small ultrasound device through the stomach. The device then generates a detailed image on a computer screen.
• X-ray of bile and pancreatic ducts — In a procedure called endoscopic retrograde cholangiopancreatography (ERCP), doctors gently thread an endoscope down the throat and through the stomach to the opening of the bile and pancreatic ducts in the duodenum. A dye passed through a thin, flexible tube (catheter) inside the endoscope allows X-ray images of the ducts to be taken.
• Pancreatic function test — This test may be conducted if a patient has lost weight or the doctor suspects a malabsorption problem. Several tests exist, but all measure the ability of the pancreas to secrete enzymes or other substances necessary for digestion.

If physicians are concerned about the possibility of other diseases, such as pancreatic cancer, additional tests may be necessary. Chronic pancreatitis patients have a higher risk of pancreatic cancer.