Diagnosing Pancreatitis

NYU Langone specialists diagnose pancreatitis, a disease in which the pancreas becomes inflamed, causing abdominal pain, tissue damage, and problems with digestion. Our gastroenterologists—doctors who diagnose and treat conditions affecting the digestive tract—specialize in the pancreas and biliary systems and provide quick medical attention to prevent complications. 

The pancreas, a gland in the abdomen behind the stomach and next to the small intestine, has two main functions. It facilitates digestion of carbohydrates, proteins, and fat by secreting two powerful enzymes, amylase and lipase, into the small intestine. It also releases hormones, such as insulin and glucagon, into the bloodstream. They help turn sugar into fuel for the body. 

When the pancreas becomes inflamed, the digestive enzymes that are meant to exit the pancreas and activate in the small intestine become activated in the pancreas instead, where they attack the pancreas, also called “autodigesting.” This leads to tissue damage, pain, and swelling. Pancreatitis can be mild, lasting three to five days, or severe, requiring medical support for multisystem organ failure.

Severe pancreatitis, especially if it is not diagnosed and treated quickly, can lead to inflammation all over the body, called systemic inflammatory response syndrome. This may result in damage to other vital organs, such as the heart, lungs, and kidneys. 

Types of Pancreatitis

There are two types of pancreatitis: acute, which develops suddenly, and chronic, which is long-term inflammation. Any episode of acute pancreatitis can cause the condition to become chronic.

Acute Pancreatitis

Acute pancreatitis happens suddenly, and most commonly occurs due to a blockage in the duct that allows the digestive enzymes amylase and lipase to leave the pancreas. Blockages are often caused by gallstones—hard deposits that may develop in the gallbladder. The gallbladder is an organ that stores bile, a digestive fluid produced by the liver. 

Because the gallbladder and pancreas share a drainage duct, called the common bile duct, gallstones that become lodged there can prevent the normal flow of pancreatic enzymes out of the pancreas, triggering inflammation.

Another possible cause of a blockage in the pancreatic duct is a form of pancreatic cancer called pancreatic ductal adenocarcinoma, which affects the cells of the duct. A tumor may form in the duct, blocking the digestive enzymes.

About one-third of acute pancreatitis episodes are caused by chronic and excessive alcohol consumption. Symptoms may arise about 6 to 12 hours after a session of heavy drinking.

Less frequently, certain medications may cause inflammation of the pancreas as a side effect, including those taken for Crohn’s disease and ulcerative colitis. Some antibiotics, diuretics, and immunosuppressive medications may raise the risk, as well as medications used to treat HIV infection and AIDS.

Other uncommon causes of acute pancreatitis include metabolic disturbances, such as hypertriglyceridemia, a condition in which certain fats in the blood, called triglycerides, are elevated. This is more likely to occur in people who have hyperparathyroidism, or overactivity of the thyroid glands. Elevated calcium levels, called hypercalcimia, can also lead to pancreatic inflammation. Rarely, pancreatitis is diagnosed as an autoimmune disease, in which the body’s immune system mistakenly attacks the pancreas, causing chronic inflammation. 

In children and adolescents, pancreatitis can be hereditary. Researchers are investigating the genetic link. 

Mild acute pancreatitis may cause abdominal pain or bloating, nausea, and vomiting. Typically, symptoms last three to five days and resolve on their own. Additional symptoms of severe acute pancreatitis include upper abdominal or back pain and fever. Pain is usually described as sharp and stabbing, typically radiating to the back, with occasional throbbing. Severe acute pancreatitis may lead to gastrointestinal bleeding, tissue death, or organ failure. 

Most people with acute pancreatitis recover fully and are able to avoid a recurrence. However, anyone who has an acute episode is at risk for the chronic form of the condition. About 25 percent develop chronic pancreatitis. 

Chronic Pancreatitis

Chronic pancreatitis is inflammation of the pancreas that doesn’t heal or improve with treatment. Long-term alcohol abuse is the most common cause. 

Rarely, chronic pancreatitis can be caused by an inherited gene mutation. This type is most often diagnosed in children or adolescents, but often the signs of the condition aren’t evident until later on. This type of gene mutation can significantly increase the risk of developing pancreatic cancer.

People with chronic pancreatitis have compromised pancreatic function and are unable to produce the enzymes necessary to absorb nutrients properly during digestion. This can result in malnutrition and steatorrhea, in which undigested fats appear in the stool. Chronic pancreatitis can also cause chronic pain around the ribs and back.

Chronic pancreatic inflammation can also damage the cells that produce insulin, a hormone that signals the cells in muscles and tissues to use glucose, or sugar, for energy. As a result, people with chronic pancreatitis are at increased risk for type 2 diabetes. They may experience acute episodes in which symptoms are more severe, such as persistent nausea, weight loss, oily stools, or diarrhea.

Diagnostic Tests

To diagnose acute pancreatitis, NYU Langone gastroenterologists take your medical history and ask about your symptoms. They may take a blood or stool sample for examination under a microscope. If the results of these tests indicate pancreatitis, your doctor may recommend one or more imaging tests to confirm the diagnosis and help determine the severity of the disease. 

Our specialists often perform multiple diagnostic tests to confirm the diagnosis of pancreatitis with certainty.

Pancreatitis is considered chronic if the pancreas remains inflamed despite treatment; this may be confirmed with follow-up diagnostic tests.

Blood and Stool Tests

Your doctor may draw a small amount of blood to check the levels of the digestive enzymes amylase and lipase. Elevated levels—meaning at least a threefold increase—is a sign of pancreatitis. 

You may also be asked to give a stool sample so your doctor can test the level of an enzyme called elastase, which indicates how well the pancreas is functioning. You are provided with a small plastic container that you fill at home and return to your doctor’s office.

Abdominal Ultrasound

An ultrasound is a test that uses sound waves to produce images of the pancreas and surrounding structures, such as the gallbladder and bile ducts, the tubes that carry digestive fluids to the small intestine. During the exam, you lie on a table as a radiologist or technician passes a wand-like device called a transducer over your abdomen. 

An ultrasound may reveal a dilated bile duct, which may indicate a blockage—a common cause of acute pancreatitis. 

Abdominal CT Scan

A CT scan involves taking a series of X-rays from different angles to show clear images of the bones and soft tissues, including organs in the abdomen. It can help reveal any abnormalities in the pancreas or the area around it, such as blockages. It may also be used to rule out other conditions that can cause abdominal pain.

Magnetic Resonance Cholangiopancreatography

Magnetic resonance cholangiopancreatography is a special type of MRI scan that allows doctors to examine detailed images of the gallbladder, pancreas, and their connective ducts. MRI uses a magnetic field, radio waves, and a computer to create highly detailed images of structures inside the body.

This test can reveal gallstones in the bile duct. If your doctor suspects that there may be a gallstone in the duct, he or she performs an endoscopic ultrasound to confirm or deny its presence. If a doctor sees a stone or stones within the duct, the next step is to remove them via a procedure called endoscopic retrograde cholangiopancreatography.

Endoscopic Ultrasound

This test uses an endoscope—a flexible tube with a light and an ultrasound probe on the end—to obtain detailed images of the pancreas, bile ducts, and surrounding organs. Your doctor gives you a local anesthetic to numb the throat and a sedative to help you relax, then glides the endoscope through the mouth or nose, down the throat and stomach, and into the small intestine, adjacent to the pancreas.

The ultrasound probe uses sound waves to produce images of the body that appear on a computer monitor. Your doctor can detect gallstones or signs of chronic pancreatitis, such as damage to the pancreatic tissue, with this test. NYU Langone gastroenterologists are specially trained to administer this test and to interpret the results.

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