How Pancreatitis is Diagnosed
Acute and chronic pancreatitis are diagnosed through a patient interview, medical exam, and several tests including blood, stool, computerized tomography (CT scan), endoscopic retrograde cholangiopancreatography (ERCP), and Magnetic Resonance Imaging (MRI).
In determining whether you have pancreatitis your doctor should ask about and consider the following:
- Your family history
- Medical history including previous pancreatitis or gallstones
- Alcohol abuse
- Current medications
- How your pain developed
- Results of laboratory and other specialized tests
- If you have had abdominal surgery, ERCP, heart surgery, or trauma to the abdomen
After taking a thorough history your doctor will perform a careful medical examination. Patients with pancreatitis can appear from normal to severely ill with fever, rapid heart rate, fast breathing and low blood pressure. The abdomen may be swollen and tender.
Tests should be run to measure blood levels of amylase and lipase (digestive enzymes made by the pancreas). High levels of amylase and lipase may indicate acute pancreatitis. However, other conditions may cause elevated amylase and lipase.
If your doctor suspects that you have acute pancreatitis based on your symptoms, examination, and amylase/lipase levels, an abdominal CT scan should be ordered.
A computerized tomography (CT scan) is a specialized x-ray that provides the most accurate way to see the pancreas. Just before the CT scan, a radiologist will inject contrast (a special medication which helps identify organs on CT scans) through an intravenous (IV) tube.
A CT scan develops the x-ray into a picture via computer, allowing doctors to accurately examine the pancreas.After the CT scan your doctor should be able to tell if your illness is due to acute pancreatitis or another disease.Your doctor can partially predict your recovery based on how your pancreas looks on CT scan and the results of your Ranson Criteria and APACHE II scores.
Your doctor may use an ultrasound or sonogram to look for gall stones. Gallstones don’t always appear on a CT scan.
An ERCP, or specialized x-ray of the bile ducts, enables your doctor to diagnose problems in the liver, bile ducts, gallbladder, and pancreas, including pancreatitis. It is used to look for the cause of pancreatitis and potentially prevent future attacks.
An ERCP combines the use of an endoscope (long, thin, flexible lighted tube) and x-ray. During an ERCP, the physician injects dye into the bile ducts and pancreas and takes an x-ray. The injected dye makes the biliary tree and pancreas appear on the x-ray picture, which helps the physician identify problems. One example would be the ability to identify and remove gallstones in the bile duct.
Patients who undergo an ERCP are given local anesthesia to numb the throat and stomach, and a sedative to help them relax during the exam. Patients then swallow the endoscope, and the physician guides it through the esophagus, stomach, and duodenum (beginning of the small intestine) to the pancreas and bile ducts, where the x-ray is taken.
Once diagnosed, the severity of pancreatitis can be measured via two common scoring systems, the Ranson Criteria and the Acute Physiologic Score and Chronic Health Evaluation (APACHE II). These scoring systems define a list of criteria - primarily age, clinical factors, and laboratory tests – that ultimately determine a patient’s score. A higher score is associated with a worse prognosis.
The scoring systems are not used to diagnose pancreatitis, they are only determined after the diagnosis. Your doctor may refer to these scores when discussing your condition with you or other doctors.