Pancreatitis (inflammatory disease of pancreas) Signs and Symptoms Diagnostic Tests

Pancreatic Diseases

Pancreatitis is inflammatory disease of pan­creas

Various presentations of Pancreatitis :

  • · Hypertriglyceridemia
  • · Vitamin B12 malsorption
  • · Hypercalcemia
  • · Hypocalcemia
  • · Hyperglycemia
  • · Ascites
  • · Pleural effusion
  • · Chronic abdominal pain.

Pancreatitis Prognosis:

  • Several techniques are used to determine how well (or how poorly) patients with pancreatitis will progress during their illness and whether they may benefit from intensive care.
  • The best of these is the APACHE II system; it grades patients with pancreatitis on the basis of 14 measurable physiological parameters, including the patient’s

Pancreatitis (inflammatory disease of pancreas) Signs and Symptoms Diagnostic Tests

Pancreatitis Classic presentation

  • Pancreatitis Signs and Symptoms
  • Pancreatitis History
  • •Similar to an acute abdomen of any cause
  • •Acute pancreatitis:
    • Alcohol use
    • Past history of gallstones
    • Family history of gallstones
    • Medication use
    • Abdominal trauma
    • Recent weight loss
  • •Chronic pancreatitis:
    • Alcohol use
    • Signs of steatorrhea
    • Signs of hyperglycemia
  • · Severe constant epigastric pain radiating to back.
  • · Elevated serum amylase.
Pancreatitis Etiology
  • · Unknown
  • · Alcohol abuse
  • · Biliary tract disease
  •  Drugs
  • · Trauma
  • · Viral infections
  • · Metabolic and connective tissue disorders.

Pancreatitis Diagnostic Tests and Interpretation


  • •No test is 100% sensitive or specific
  • •Acute pancreatitis:
    • Elevated serum amylase (amylase P)
    • Elevated serum lipase
    • Liver function tests (LFTs): Hyperbilirubinemia and elevated (mild) ALT, AST, and/or alkaline phosphatase when associated with alcoholic hepatitis or choledocholithiasis
    • Glucose increased in severe disease
    • Calcium decreased in severe disease
    • White blood cells (WBCs): 10,000–25,000/µL

Other Tests

  • Serum Amylase: In patients with acute abdominal or back pain, estimation of serum amylase is done.
  • If serum amylase is more than 65 units/litre, acute pancreatitis is a possibility.
  • If serum amylase is more than 130 units per li­ter, the diagnosis is pancreatitis.
  • In acute pancreatitis, serum amylase is increased from 24 hours to 3 days and returns to normal in 5 days.
  • In acute pancreatitis, sometimes serum amylase may not be increased as in :
  • 1. Late sample – after 5 days
  • 2. In chronic pancreatitis
  • 3. Hypertriglyceridemia.
  • False elevation of serum amylase is seen in carcinoma lung, oesophagus, breast, ovary.
  • Urinary amylase is not sensitive or specific. Elevation of pleural fluid and ascitic amylase occurs in other conditions also.
  • Serum amylase more than 3 times normal is best test and highly specific for pancreatitis.
  • Serum trypsinogen is elevated and is very specific for pancreas, but less sensitive.
  • Normal is 28 to 58 ng/ml. Less than 20 ng/ml means> pancreatic steatorrhea.
  • Trypsinogen levels are increased in pancreatitis as well as renal failure.
  • Single best enzyme test for acute pancreatitis is li­pase estimation.

Tests for Pancreatic Structure X-ray: shows

  • 1. Localized ileus in jejunum (sentinel loop)
  • 2. Generalized ileus with air fluid levels
  • 3. Colon cut-off sign (isolated distension of trans-
  • verse colon)
  • 4. Duodenal distension with air fluid levels
  • 5. Massive pseudocyst
  • 6. In chronic pancreatitis – pancreatic calcification on and around second lumbar vertebra.

Ultrasound: shows

  • · Edema
  • · Inflammation
  • · Calcification
  • · Pseudocyst
  • · Mass lesions
  • · Gall stones.
  • In acute pancreatfti~ pancreas is enlarged. Pancreatic pseudocyst – echo-free smooth round fluid collection.
  • In pancreatic carcinoma – distortion of normal struc­tures.
  • If more than 3 cm localized echo-free solid lesion seen, it is usually carcinoma.
  • In obesity and gas in large bowel, pancreas difficult· to see.

CT is best for:

  • · Chronic pancreatitis and complications.
  • · Pancreatic tumors
  • · Pancreatic pseudocyst
  • · Abscess
  • · Calcium deposition.
  • Dynamic CT using rapid IV contrast is for pancreatic necrosis to predict mortality and morbidity.
  • Spiral CT is very good.

Endoscopic ultrasonography (EUS)

  •  is done to see pancreatic parenchyma and pancreatic duct, common bile duct stones, pseudo cyst.
  • Endoscopic ultrasound (EUS) is better than Endoscopic retrograde cholepancreatography (ERCP).
  • EUS is also for:
  • Biopsy
  • Nerve blocks through EUS Dilatation of main pancreatic duct.

Magnetic Resonance Cholepancreatography (MRCP)

  • To see –
  • Pancreatic duct Bile duct
  • It is useful in elderly as it is a dure.
  • Selective catheterization
    • of celiac and superior mesenteric arteries, and hepatic, splenic, and gas­trgduodenal arteries for angiography.
    • Percutaneous aspiration biopsy of pancreatic mass is done to differentiate between inflammatory swelli’ng and neoplasm.
  • Exocrine pancreatic function
    • 1. Direct stimulation of pancreas by IV infusion of secretin, or secretin plus CCK (cholecystokinin), then measurement of duodenal contents.
    • 2. Study of digestion products from lumen like un­digested meat fibers, stool fat, fecal nitrogen.
    • 3. Measurement of pancreatic enzymes like elastase.


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