Diagnosis of the pancreas should be carried out comprehensively, it is important to know not only information about the structure of the organ. But understand how it works and know how to check the pancreas.
The pancreas has a fairly large size, it has a unique structure and interesting features. She has a major role in the process of digesting food, since enzymes are formed in it, they are necessary for the breakdown of proteins and fats to form compounds that, when released into the blood, nourish the cells. In this gland, insulin is formed, which helps glucose (the main source of energy) to penetrate into the cells of organs and tissues. Other hormones are also synthesized in the gland.
The pancreas is located in the retroperitoneal space, in front of it is the stomach, the duodenal ulcer, the colon and the transverse intestine, and the sides are the kidneys. The organ has internal ducts into which pancreatic juice containing enzymes is collected from glandular cells. All ducts are connected in one large. Which goes into the duodenum.
If some part of the gland is damaged, the remaining tissues take over its function, and the disease may not manifest itself. At the same time, in some cases, a very small area that is imperceptible in the general structure of an organ can become inflamed or die off, but the function of the gland varies greatly. That is why it is necessary to conduct a comprehensive examination of the pancreas to cover its entire structure and explore the functions.
During the examination of the pancreas, analyzes are carried out to determine the efficiency of the organ. In acute lesions increases the activity of enzymes synthesized by the gland. Some of them are better defined in the urine, others in the blood, others in the feces.
To assess the severity of the lesion, it is also necessary to examine the functioning of the liver, as it is closely related to the pancreas.
Analyzes carried out in the diagnosis of pancreas:
- Complete blood count – if there is an acute process or exacerbation of a chronic disease, then the level of leukocytes, segmented and stab neutrophils, and ESR will be increased.
- Biochemical analysis of blood – there is an increased amount of direct and total bilirubin (with the icteric form of the disease), the level of gamma globulins, sialic acids and seromucoid rises.
Specific analyzes specific to this body:
- blood alpha-amylase (normally it should be 16-30 g / liter per hour);
- trypsin activity (should not exceed 60 µg / liter);
- blood lipase 9 in pathology exceeds the level of 190 U / liter);
- blood glucose – will matter above 6 mmol / liter, if inflammatory or destructive processes encompass the insular (endocrine) part of the organ;
- determination of amylase, trypsin and lipase in the lumen of the duodenum on an empty stomach, and then after the diluted hydrochloric acid solution (30 ml) is fed into the intestine. Normally, these enzymes in the first two parts of the contents of the intestine have a reduced level, and then they gradually increase to the initial value. In chronic pancreatitis in all portions there is a noticeable decrease;
- urinalysis – determine the activity of amylase and the number of amino acids (Lasus test). When the pathology of the gland, these substances will be observed in increased quantities;
- coprogram – with insufficient pancreatic function in the feces will be starch, fat, muscle fibers and undigested fiber.
Currently, the main criterion for the laboratory diagnosis of pancreatic diseases is estalase – an enzyme located in feces. If the iron works poorly, then the activity of pancreatic estalase will be at a level below 200 µg / g, if there is a severe organ pathology, then less than 100 µg / g.
Laboratory stress tests
Sometimes it is necessary to carry out some analyzes not only on an empty stomach, but also after the intake of certain substances in the body – a stress test is carried out.
Types of stress tests:
- Glyco-amylase test – this determines the initial concentration of amylase in the blood, and then the person drinks 50 g of glucose. After three hours, do another test for amylase. With disease, the amount of this enzyme will be 25% higher than the initial level.
- Prozerin test – determine the initial level of urine diastase, then enter the drug Proserin. Then two hours every thirty minutes, the diastase content is measured. Normally, its amount rises no more than twice, and then returns to its original value. In various pathologies of the gland, the indicators will differ.
- Iodolipol test – the patient should urinate on waking, and then drink the drug Yodolipol. Then, for 2.5 hours every half hour in the urine, iodide levels are determined. The basis of this diagnosis is the activity of lipase secreted by the gland. Normally, iodide in urine begins to be determined after an hour, the degree of its excretion increases and reaches a maximum in a urine sample taken after 2.5 hours.
- Secretin-pancreatic imine sample – to conduct it, change the chemical composition of the contents of the duodenum after the supply of secretin (hormone-like substance) to it. It increases the secretion of pancreatic juice in the intestine, which contains a lot of bicarbonates and enzymes.
- Glucose tolerance test, – allows you to determine the pathology in the endocrine apparatus of the pancreas. In this case, first determine the content of glucose in the blood on an empty stomach, and then after 60 minutes and two hours after eating inside the glucose solution. This analysis can only be prescribed by an endocrinologist and he should also interpret the results, as he is likely to develop complications that occur when the blood glucose concentration is high.
Study of the structure of the body
The study of the gland is determined by the properties of its tissue. The usual X-ray examination will not show anything, but the organ ducts can be seen with the help of X-rays when a contrast agent is inserted into them.
It is possible to study the gland well with the ultrasound method, and it is possible to determine the intensity of the blood flow in its vessels using doppler sonography. Computed tomography makes layered visualization of the structure, and its magnetic resonance analog allows you to determine the smallest structures in the body.
X-ray examination methods:
- Survey X-ray – only calcification of the glandular tissues and large stones in the ducts are visualized.
- Endoscopic retrograde cholangiopancreatography – a contrast agent is injected into the ducts of the gland using an optical apparatus for fibrogastroscopy from the duodenum.
- Selective angiography – Contrast agents are delivered to the vessels of the gland, and then they are examined using x-rays.
- Computed tomography – allows you to diagnose tumors and inflammatory processes in the body.
- Ultrasound examination is not, in contrast to tomography, a very accurate method, but it is very simple and safe, therefore, it is the basis for making a primary diagnosis. With the help of ultrasound, you can see acute and chronic inflammation, cyst, tumor, abscess. Doppler ultrasound is very important for assessing the blood supply to the organ. Immediately, we note that a pancreas ultrasound will be required.
- Magnetic resonance imaging – the most informative method is NMR tomography, it allows you to visualize the organ tissue by layers with maximum accuracy. If the MRI is combined with the introduction of a contrast agent into the ducts (cholangiopancreatography) or vessels (angiography), then the accuracy of studying the gland will be maximal.
Before each of these methods, the patient must undergo preparatory procedures.
The use of MRI has the following indications:
- liver pathology;
- small gland tumors;
- preparation for surgery;
- control organ therapy.