How to check for pancreatitis?

Written by Yang Chun Guang
Gastroenterology
Updated on September 30, 2024
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Pancreatitis can cause acute abdominal pain, along with symptoms of nausea and vomiting, and severe cases can lead to hypotensive shock. In laboratory tests, the diagnosis is generally made by assessing serum or urine amylase levels. An amylase level that exceeds three times the normal value can diagnose pancreatitis. Additionally, ultrasound and CT scans can reveal an enlarged or exuding pancreas, and the presence of a small amount of fat necrosis around the pancreas can be diagnosed as pancreatitis. The onset time of serum amylase in pancreatitis varies; typically, serum amylase begins to increase between 6 and 12 hours and starts to decline after 48 hours, and can be detected within 3 to 5 days. Lipase levels typically start to rise between 24 to 72 hours and remain elevated longer, up to 7 to 10 days. Thus, lipase has diagnostic value for later stages of pancreatitis and tends to have higher specificity compared to amylase.

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Severe Pancreatitis Criteria

Acute pancreatitis with persistent organ failure lasting more than 48 hours is considered severe pancreatitis. In the early stages of the disease, organ failure starts with a systemic inflammatory response produced by the activation of a cytokine cascade, involving the continuous failure of single or multiple organs. Such patients often have one or more local complications, with organ failure that can persist for several days after onset. The mortality rate can reach 36% to 50% once organ failure occurs. Infections in such patients can dramatically increase the mortality rate. CT imaging may show gas bubbles in peripancreatic necrotic tissue and fluid collections. Diagnosis is confirmed by positive results from either a smear of aspirate obtained via image-guided fine-needle aspiration or from bacterial cultures.

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Severe pancreatitis treatment process

Severe pancreatitis generally develops rapidly, progresses urgently, and can even be life-threatening. Therefore, the main treatment initially involves fasting, gastrointestinal decompression, suppression of pancreatic enzyme secretion, promotion of gastrointestinal motility, and maintaining regular bowel movements. Antibiotics can be used to prevent infection and necrosis of pancreatic tissue. If necrotic pancreatic tissue and ascites occur in the abdominal cavity, appropriate puncture and drainage may be used.

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What fruits can you eat with pancreatitis?

Patients with pancreatitis can eat some mild fruits, such as apples, bananas, peaches, kiwis, and strawberries. It is best to avoid more acidic fruits like oranges, lemons, and hawthorns. For cooler fruits, they can be soaked in warm water for a certain period before eating. Also, regardless of the type of food, fruit, or daily diet, it is important not to overeat.

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Causes of Pancreatitis

Common causes of pancreatitis in clinical settings include biliary tract diseases, alcohol consumption, overeating, and hyperlipidemia, among others, with biliary tract diseases being the most common. Pancreatitis is generally defined as inflammatory changes in the pancreas due to self-digestion caused by various reasons. Clinical manifestations include abdominal pain, bloating, nausea, and vomiting, etc. Therefore, for patients with upper abdominal pain, it is necessary to further complete some examinations, such as liver function, amylase, lipase, abdominal ultrasound, and even abdominal CT scans, to clarify the diagnosis, which is generally straightforward for pancreatitis. The treatment of pancreatitis, in addition to symptomatic treatment, requires etiological treatment, combining different causes of pancreatitis. For instance, if caused by hyperlipidemia, lipid-lowering treatment is generally needed; if biliary tract disease is considered, active treatment of the biliary disease is required.

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How to treat mild pancreatitis

Pancreatitis occurs due to the abnormal activation of pancreatic enzymes, leading to the self-digestion of the pancreas. The primary causes include alcohol, where excessive drinking can induce acute pancreatitis. Another cause is hyperlipidemia, as individuals with high blood lipid levels are prone to acute pancreatitis. Additionally, cholelithiasis, including stones in both the bile ducts and the gallbladder, can also trigger acute pancreatitis. Symptoms of acute pancreatitis manifest as severe pain in the upper abdomen, accompanied by nausea, vomiting, abdominal bloating, and fever. Acute pancreatitis is classified into mild, moderate, and severe categories. Mild cases mainly exhibit edema of the pancreas without bleeding, necrosis, or involvement of other organs. Treatment primarily involves fasting and fluid replacement, typically lasting for more than 48 hours or until abdominal pain ceases. Another aspect of treatment is inhibiting pancreatic enzyme secretion. Some patients with acute pancreatitis might also need antibiotics. Typically, mild acute pancreatitis can heal within one to two weeks of treatment.