Diagnosis of pancreatic diseases in adults
Violations of the pancreas lead to problems with the gastrointestinal tract, and often to endocrine pathologies, such as diabetes. In order not to bring to trouble, timely diagnosis is needed. Let’s talk about it with the experts

The pancreas is an important organ of the digestive and endocrine systems. It produces amylase, lipase, and other enzymes for the digestion of proteins, fats, and carbohydrates, as well as the hormones insulin, glucagon, and somatostatin.

Under the influence of adverse internal and external factors, inflammatory processes occur in the pancreas, benign and malignant neoplasms develop. Diagnosis of the pancreas allows you to detect pathologies, prescribe adequate treatment and monitor the results of therapy.

Together with our experts, we found out in which cases a pancreatic diagnosis is required in adults. They also specified what laboratory and instrumental methods modern medicine uses to diagnose pancreatic diseases.

Why and when to check the pancreas

Violations of the pancreas lead to digestive disorders, and often to endocrine pathologies, in particular, diabetes mellitus.1. This disease develops when there is a deficiency of insulin, which regulates blood glucose levels. One of the most dangerous diseases of the pancreas is acute pancreatitis. It often causes peritonitis, pancreatic abscess and other serious complications that can be fatal and require urgent medical attention.2.

Timely diagnosis of pancreatic diseases allows you to start treatment on time and prevent the development of complications. Doctors recommend getting tested in the following cases:

  • with pain in the left hypochondrium and in the upper abdomen or girdle pain, nausea, vomiting, the appearance of a “fatty” mushy stool with an unpleasant odor;
  • in the presence of diseases of the liver, gallbladder and biliary tract, as well as peptic ulcer of the stomach and duodenum 12;
  • people who smoke and abuse alcohol;
  • to monitor the results of therapy for pancreatitis and other pancreatic pathologies;
  • in the presence of close relatives with diseases of the pancreas;
  • as part of a preventive examination – for men and women. over 35 years old.

The plan of the diagnostic examination is made by the doctor after examination and history taking. Therefore, the set of methods will differ depending on the state of health, age and other characteristics of the patient.

Methods for diagnosing the pancreas

During the initial examination, the doctor probes and taps certain points on the abdomen. Normally, the pancreas is not palpable, and palpation will be painless. For a more accurate diagnosis of pancreatic diseases, instrumental and laboratory methods are used.

Instrumental methods for diagnosing the pancreas are used to assess the size and anatomical features of the organ, determine the condition of the ducts, the presence of tumors and stones.

With the help of laboratory studies, the hormonal and enzymatic activity of the gland is studied. Next, we will describe the most common research methods.

Ultrasound of the pancreas

Ultrasound is the simplest and safest diagnostic method. With its help, you can determine the size, location and structure of the organ, see unevenly dilated ducts, detect neoplasms and inflammation, identify calcification and the presence of stones3. Ultrasound is used as part of the standard primary diagnosis for suspected pancreatic diseases.3. To make a more accurate diagnosis, additional studies are prescribed, including CT and MRI of the pancreas.

MRI of the pancreas

Thanks to magnetic resonance imaging, changes in the density of the gland, calcifications, pseudocysts, tumors, and inflammatory processes can be determined. Most often, MRI is prescribed for suspected neoplasms and for injuries of the abdominal organs in order to assess the degree of damage to the gland.

CT scan of the pancreas

Computed tomography is used if it was not possible to make an accurate diagnosis using other methods. In addition, this diagnostic method makes it possible to distinguish such diseases and conditions as acute and chronic pancreatitis, cysts and pseudocysts, malignant and benign tumors from each other. Multispiral CT is the method of choice for the primary diagnosis of chronic pancreatitis (its sensitivity and specificity are 75–90%)3.

Esophagogastroduodenoscopy (EGDS)

EGDS is an endoscopic examination to study the mucous membrane of the stomach and duodenum 124. With pancreatic pathologies, changes are observed in the mucosa of these organs, and the organs themselves are deformed under the pressure of an enlarged pancreas.4. The study is carried out using an endoscope, which is inserted through the oral cavity. The image from the camera is transferred to a computer and decoded.

Endoscopic retrograde cholangiopancreography (ECPG)

This is an endoscopic method for examining the upper and middle sections of the digestive tract. With its help, the state of the pancreatic ducts, the presence of stones and neoplasms are determined. During the examination, an endoscope is inserted into the oral cavity – a special tube with a camera. As soon as the endoscope reaches the duodenum, a catheter is inserted into it, through which a radiopaque substance enters. After that, a series of images are taken using X-rays, which give a visual representation of the state of the structures under study.

Assays

Patients with suspected pancreatic pathology are prescribed blood, urine and feces tests. Laboratory tests allow us to evaluate the enzymatic and hormonal activity of the pancreas, to identify inflammatory processes, autoimmune and oncological diseases.

Most often, the following tests are used to diagnose diseases of the pancreas:

  • general blood analysis;
  • general urine analysis;
  • biochemical blood test with determination of total protein and its fractions, bilirubin, transaminases, alkaline phosphatase, alpha-amylase, lipase, trypsin, glucose;
  • coprogram – analysis of feces to assess how food is digested;
  • urinalysis for alpha-amylase.

In addition, the doctor may prescribe additional tests for a detailed study of the functions of the pancreas. For example, an increase in the level of pancreatic and serum elastase in the blood indicates an acute inflammatory process.4. The level of C-peptide in daily urine can suggest diabetes mellitus and malignant tumors.4. The presence of antibodies to pancreatic beta cells in the blood serum is observed in diabetes of autoimmune origin.4. An increase in the level of CA 19–19 in the blood occurs against the background of oncological diseases and acute pancreatitis.4.

Preparing an Adult for a Pancreatic Diagnosis

Preparation depends on the type of diagnostic procedure and the condition of the person. The doctor who prescribes instrumental studies and laboratory tests should tell about the features of the preparatory stage. But there are still a few general preparation rules:

  • a general and biochemical blood test is taken on an empty stomach, on the day of the examination they do not do droppers and some diagnostic procedures, such as CT with contrast and fibrogastroduodenoscopy;
  • before submitting the biomaterial to the coprogram, do not take sorbents, laxatives and enzyme preparations, do not use rectal suppositories and enemas;
  • before an ultrasound of the pancreas, they refuse food, water and smoking for 6-8 hours, within 2-3 days before the examination, fried and fatty foods and foods that cause gas formation are excluded from the diet;
  • MRI is performed on an empty stomach, within 2-3 days before the procedure, do not eat foods that provoke bloating, remove jewelry and metal parts of clothing before the examination;
  • before a CT scan with contrast, they take tests for creatinine and urea, do not drink alcohol and gas-forming products for several days, 8 hours before the procedure they refuse food and water;
  • On the day of the ECPG, do not eat or drink, do a cleansing enema the night before and take sedatives.

Certain medications can interfere with an accurate diagnosis. Therefore, the patient should tell the attending physician about the drugs that he takes on a regular basis.

Where to check the pancreas

In public and private clinics, laboratories and diagnostic centers. You can be examined during your vacation in a sanatorium that specializes in the treatment of diseases of the gastrointestinal tract.

Popular questions and answers

Pancreatic diseases are one of the most common pathologies of the digestive system in adults.2. In addition, there is a trend towards an increase in the incidence – for example, the number of patients with acute and chronic pancreatitis has doubled over the past 30 years in the world.2. At the same time, many diseases can be prevented, while others can be successfully cured at an early stage. Therefore, the issues of timely diagnosis of pancreatic diseases are of concern to many. Our experts tell you how often you need to undergo examinations and which doctor to contact.

Where is the pancreas located?

Contrary to its name, this organ is not located under the stomach, but behind it on the back wall of the abdominal cavity, next to the kidneys.2. The pancreas is projected onto the anterior part of the abdominal wall in the left hypochondrium and epigastric region, therefore, during the pathological process, pain and discomfort are observed in this area2. The pancreas consists of a tail, body and head and has an average size of 18 to 22 cm2.

Which doctor checks the pancreas?

Usually this is done by a therapist or a gastroenterologist – a specialist in the diagnosis and treatment of the digestive system. Sometimes an examination by another narrow specialist is required, such as a surgeon, endocrinologist, and oncologist. Instrumental studies of the pancreas are performed by ultrasound diagnosticians, radiologists, MRI diagnosticians.

How often should the pancreas be checked?

Patients with pancreatic disease should be examined once or twice a year or more often depending on their condition. In addition to undergoing ultrasound, they need to take a general and biochemical blood test with a study of serum amylase, protein and protein fractions, as well as a urine test for alpha-amylase. For healthy people over 1 years of age, a screening examination of the pancreas is recommended at least once every 2–35 years.
  1. Acute and chronic diseases of the pancreas. Teaching aid for students of 4-5 courses of medical universities. Department of faculty and hospital surgery. Krasnodar. 2020
  2. Introduction to ultrasound diagnostics of pancreatic diseases. https://clck.ru/aeyyn
  3. Recommendations of the Russian Gastroenterological Association for the diagnosis and treatment of chronic pancreatitis. year 2014.
  4. Outpatient diagnostics and treatment of the biliary system and pancreas. Teaching aid. Belarusian State Medical University. 2005 year. http://rep.bsmu.by/bitstream/handle/BSMU/8715/Zabol_biliarn_sist.pdf?sequence=2&isAllowed=y

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