How to examine the pancreas: tests and diagnostic tests
Still a decade and a half ago the first places among acute surgical diseases of the peritoneum were occupied by cholecystitis and appendicitis, today the dubious palm tree belongs tostroma pancreatitis. Failures in the pancreas work, generating necessary for digestive pancreatic juice and hormones glucagon and insulin, that regulate the level of glucose in the blood, is fraught with serious consequences and impact on the activities of all organs of the human body.
In order to identify and subsequent effective treatment of such diseases as pancreatitis, cysts, stones in the ducts, necrosis and cancer, as well as appearing on their background duodenal diseases, stomach, intestines and liver, should be carefully and promptly examine the pancreas.
In modern medical practice, various analyzes and methods are used for this, each of which, having its own characteristics, is appropriate for a particular pathology.
Scheme diagnostic
order to conduct a survey of the body necessary to apply to the therapist, and then to the gastroenterologist or endocrinologist, hearing patient complaints and investigating during inspection and palpation of the pancreas, pay attention to the stomach and the liver, and then designate correspondingDiagnostic procedures. Typically, acute pancreatitis and other diseases including organ laboratory diagnostic methods using such analyzes and investigations as:
- biochemical blood tests to determine the level of pancreatic amylase;
- stool analysis for undigested food and steatorrhea( increase in neutral fats);
- biochemical analysis of urine, revealing the level of diastase;
- ultrasound examination to determine the shape and size of the pancreas, as well as the presence of cysts and tumors;
- X-ray, MRI and CT of the pancreas, liver, duodenum and stomach, allowing to reveal indirect signs of pathology of organs;
- biopsy assays;
- diagnostic tests.
diagnostic tests
X-ray and ultrasound studies of the pancreas is often combined with tests to examine and evaluate the exocrine function of the organ, which, however, for diagnostic purposes and can be used independently. They can be conditionally divided into groups such as:
- tests that require the introduction of an intestinal probe;
- non-probe or non-invasive tests.
The advantages of the latter are considerable comfort and no risk to the patient when using them, as well as at a low cost. Based on the definition of reduced secretion of pancreatic enzymes, such tests, however, have insufficient sensitivity and specificity and are effective only with a significant decrease in enzymatic secretion.
Probe and tubeless examination methods are not required for each patient with pancreatic disorders, bowel, gastric, or liver, the selection is made in each case individually.
Among the diagnostic tests, the most common are:
- pancreosimine-secretin;
- hydrochloric acid;
- Lund test;
- is elastase.
Pancreosimine secretin test
The majority of physicians consider the use of pancreosimine-secretin test to be the gold standard for the detection of violations of exocrine pancreatic function. When it is carried out under the control of fluoroscopy, a double-lumen probe is administered to the patient on an empty stomach, while performing a constant aspiration. Consecutive samples of duodenal and gastric contents are collected the required number of times after intravenous injection of secretin and pancreosimin. Analyzes of aspirates are examined by measuring the concentration of bicarbonates, the rate of secretion and the activity of trypsin.
In pancreatitis, the patient notes:
- a significant decrease in secretion;
- reduced concentration of bicarbonates;
- increased concentration of enzymes.
Detected enzyme deficiency indicates chronic pancreatitis. If, as a result of the pancreosimine-secretin test, bicarbonate alkalinity is detected, the patient should be examined in an oncological dispensary, since such indicators are characteristic for both chronic pancreatitis and malignant neoplasms of the pancreas head. Obtaining false positive results is possible with diabetes mellitus, biliary dysfunction, liver cirrhosis and hepatitis.
Subject to all required specifications, the diagnostic accuracy of the method is very high. Its disadvantages can be attributed only to the onerousness for the patient of duodenal sounding, the complexity of laboratory work and the rather high cost of stimulants.
Hydrochloric acid test
As a stimulant of pancreatic secretion, this test uses a 0.5% solution of hydrochloric acid, which is injected intraduodenally through a probe, with the addition of olive or sunflower oil. The method of sampling and analysis of the pancreatic secretion is the same as in the case of injectable stimulants.
This survey method is quite simple and accessible, however, the accuracy of the data obtained as a result of it is slightly lower than in the previous test. Due to this, and considering that simultaneously carrying out 2 tests is unacceptable, it will be better to start with pancreosimine-secretinovy.
Lund test
This test, described by Lund in 1962, is based on the collection of intestinal contents by intubation after taking a standard food sample and is aimed at evaluating the exocrine function of the pancreas. In the morning on an empty stomach, a radiopaque probe made of polyvinyl chloride with a mercury or steel load attached to its end is injected into the patient and a standard food mixture including vegetable oil and dried milk with dextrose is added. After taking the mixture, the duodenal aspirate is collected for 2 hours, placing the assays in ice containers.
Similar examination of the pancreas is aimed at determining the level of amylase, which is most often overestimated in pancreatitis. Advantages of this method include simplicity, availability and absence of the need for intravenous injections, to disadvantages - the possible error of results due to the inevitable addition of gastric juice and bile. False positive results are obtained in patients with diabetes mellitus, gastrostomy, and certain liver diseases.
Elastase test
In contrast to known non-invasive tests, this method allows to detect endocrine pancreatic insufficiency in pancreatitis already at an early stage. Analyzes with the detected enzyme deficiency testify to chronic inflammation of the organ. This examination, which is indicated by the diagnosis of the disease with chronic or acute pancreatitis, and the effectiveness of the treatment, is to determine the elastase in the stool of the patient.
Study of elastase of feces is shown in both chronic pancreatitis and diabetes mellitus, cholelithiasis and some liver diseases.
The pancreas, being one of the most important organs of the human body, requires careful treatment and constant monitoring. All her diseases require immediate adequate treatment, which is possible only with timely examination and proper diagnosis. And in this patient the caring hands of doctors and modern methods of examination are called upon to help.
