How to check for pancreatitis?

Written by Chen Rong
Gastroenterology
Updated on January 17, 2025
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The examination of pancreatitis requires laboratory tests and imaging examinations to assess the severity of the condition and to identify the cause. Elevated amylase and lipase levels more than three times the normal values, increased white blood cells, elevated C-reactive protein, increased blood sugar, elevated transaminases and bilirubin, decreased albumin, increased urea nitrogen and creatinine, decreased blood oxygen partial pressure, decreased blood calcium, elevated triglycerides, and abnormalities in blood sodium, potassium, and pH values all reflect the severity of pancreatitis. Abdominal ultrasound is a routine initial screening imaging examination for acute pancreatitis, and abdominal CT is helpful in confirming the presence of pancreatitis, peripancreatic inflammatory changes, and pleural effusion. Enhanced CT is beneficial in determining the extent of pancreatic necrosis and is generally performed about a week after the onset of the condition. However, when searching for the cause of pancreatitis, the sensitivity and accuracy of CT are not as good as MRI, therefore further MRI should be conducted to investigate causes related to the bile duct and to determine the cause of the pancreatitis.

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Written by Zhu Dan Hua
Gastroenterology
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Where does pancreatitis hurt?

Pancreatitis generally presents as abdominal pain, specifically in the upper abdomen, the area above the navel, and near the xiphoid process. The pain is usually continuous and may intensify intermittently. Some patients also experience intolerable radiating pain in the lumbar and back areas, which can improve when they bend over. Patients commonly experience nausea and vomiting, which typically involve stomach contents without blood. Some patients may also have a fever, most commonly a low-grade fever between 37°C and 38.5°C. Patients usually seek medical attention for abdominal pain, and the pain in the upper abdomen and back area is a common complaint. To further clarify the diagnosis, patients typically need to undergo tests such as amylase evaluation, abdominal CT, and abdominal ultrasound. After these tests, a diagnosis of pancreatitis can usually be made. Treatment initially focuses on symptomatic management and medical treatment.

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Written by Yang Chun Guang
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How to check for pancreatitis?

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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Written by Wei Shi Liang
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Rescue of severe pancreatitis

Severe pancreatitis involves severe illness impacting multiple systems and organs across the body. The rescue of severe pancreatitis should be based in the ICU, with multidisciplinary cooperation. The first step is early fluid resuscitation, with crystalloid solution preferred, and it should be rapidly completed within 48 hours of onset. The second step involves support for circulation and respiration. The third step involves the maintenance of organ functions and the use of blood purification treatments. Early use of blood purification in acute pancreatitis can remove inflammatory mediators, regulate immune dysfunctions, and protect organ functions, potentially extending the survival time of patients with severe pancreatitis. The fourth step includes monitoring intra-abdominal pressure and preventing and treating abdominal compartment syndrome. Further treatments mainly include the use of agents to inhibit pancreatic enzymes and platelet activation, as well as early jejunal nutrition. Additionally, prophylactic use of antibiotics is required, and in cases of biliary acute pancreatitis, ERCP or sphincterotomy should be performed. The final approach is surgical treatment, which is reserved for patients who do not respond to or have poor results from conservative treatment.

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Written by Wu Hai Wu
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Can pancreatitis be contagious?

Pancreatitis is not contagious; it is a serious digestive system disease. The main causes of pancreatitis include gallstones, binge eating, alcohol abuse, and consumption of greasy foods among other factors. Once an attack of pancreatitis occurs, the patient must immediately refrain from eating and drinking, undergo gastrointestinal decompression, and have gastric juices, acids, and stomach contents suctioned out. Meanwhile, treatments for pancreatitis may involve the use of somatostatin or octreotide to inhibit the secretion of pancreatic juice, as well as the use of third-generation cephalosporins or quinolone antibiotics for anti-infection treatment. (Please use medications under the guidance of a physician.)

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What can be eaten with severe pancreatitis?

Patients with severe pancreatitis should not eat orally. Historically, suppressing pancreatic enzyme secretion by resting the intestines has been considered an important means of controlling the progression of acute pancreatitis. Currently, the implementation of early enteral nutrition is proposed. Early enteral nutrition should be administered via a jejunal tube, which is safer. The nutritional formulation should be chosen based on the patient's condition and intestinal tolerance. Initially, only glucose water may be used to allow the intestines to adapt to the nutrition. Early nutrition should use low-fat preparations containing amino acids or short peptides, because whole proteins entering the intestine directly without being digested by stomach acid can cause indigestion. As the condition enters the recovery phase, the feeding amount and rate can be gradually increased, and preparations containing whole proteins may be given.