What tests should pancreatitis do?

Laboratory examination 1. During acute attack, leukocytosis and pancreatic enzyme activities increased, and pancreatic enzyme activities were normal or low between two attacks. 2. Fat drops and undigested muscle fibers can be seen under the stool examination microscope. Red balls of different sizes can be seen after Sudan ⅲ alcohol staining. This method can be used as a basic method for simple primary screening. 3. Others, such as glucose tolerance test, serum bilirubin and alkaline phosphatase, are helpful for the diagnosis of chronic pancreatitis or for a comprehensive understanding of liver function and biliary obstruction. 4. The secretion of lipase and protease can be understood by the fat and nitrogen balance test, which can be used to check the exocrine function of pancreas. Starch tolerance test can understand the secretion of amylase. (1) Pancreatic stimulation test: Intravenous injection of secretin, cholecystokinin-trypsin (CCK-PZ) or kemelin can stimulate pancreatic secretion, and the pancreatic juice is taken out from the duodenal drainage tube on time to observe the amount of pancreatic juice. In chronic pancreatitis, secretion decreases. (2)PABA test: Although simple, it has poor sensitivity and is influenced by many factors. Patients with severely impaired pancreatic function are prone to positive results. (3) The content of chymotrypsin in feces of 49% patients with early chronic pancreatitis decreased, and that of chymotrypsin in feces of 80% ~ 90% patients with late chronic pancreatitis decreased. (4) Cholesterol-13c- octanoic acid breath test: it is also a non-invasive method to check pancreatic exocrine function. For example, the decrease of cholinesterase secreted by pancreas can be detected by labeling exhaled CO2 with 13c. Its sensitivity and specificity are good. (5) Recent reports also show that the determination of elastase content in feces is of great help to chronic pancreatitis, with a sensitivity of 79% and a specificity of 78% if the influencing factors such as small intestinal diseases are excluded. Elastase reduces fecal excretion in chronic pancreatitis. (6) The determination of CCK-PZ in blood by radioimmunoassay is helpful for the diagnosis of chronic pancreatitis. Normal fasting is 60pg/ml, and patients with chronic pancreatitis can reach 8000pg/ml. This is due to the decrease of pancreatic enzyme secretion in chronic pancreatitis and the weakening of feedback inhibition on CCK-PZ secreting cells. Blood biochemistry: 1. The white blood cell count may not increase or slightly increase in mild pancreatitis, but it often increases significantly in severe pancreatitis with infection and neutrophils. 2. Amylase determination This is one of the important objective indicators for the diagnosis of acute pancreatitis, but it is not a specific diagnostic method. At the early stage of the disease, when pancreatic vascular embolism and partial hemorrhagic necrotizing pancreatitis occur, it may not get worse because of the serious damage to pancreatic tissue. Sometimes, in the case of shock, acute renal failure, pneumonia, mumps, ulcer perforation and intestinal and biliary tract infection, amylase can also increase. Therefore, when there is an increase in amylase, it is necessary to combine the medical history, symptoms and signs to exclude the increase in amylase caused by non-pancreatic diseases in order to diagnose acute pancreatitis. Isozymes in pancreas can be significantly increased. For patients with high suspicion of pancreatitis and normal amylase, it is more valuable to determine whether the amylase with hyperamylasemia comes from pancreas. 3. Blood chemical examination showed that the binding force of carbon dioxide decreased and blood urea nitrogen increased in severe pancreatitis, indicating that the kidney had been damaged. When the islets of Langerhans are destroyed, blood sugar may rise, but most of them are short-lived. In hemorrhagic pancreatitis, blood calcium often decreases, and when it is lower than 7mg%, it often indicates a poor prognosis. 4. radioimmunoassay (RIA) Because amylase determination is not specific for the diagnosis of pancreatitis, with the development of immunoassay technology, many scholars are looking for a more accurate diagnostic method, that is, radioimmunoassay of pancreatic enzyme. At present, there are several enzymes detected: immunoactive trypsin (IRT), elastase Ⅱ, trypsin inhibitor (PSTI) and phospholipase A2(PLA2). Imaging examination: 1. X-ray examination of acute pancreatitis (1) Abdominal plain film: ① Increased pancreatic density (exudation due to inflammation); ② Reflex intestinal stagnation (mainly in stomach, duodenum, jejunum and transverse colon); ③ Diaphragm elevation and pleural effusion; ④ Pancreatic stones or bile duct stones can be seen in a few cases; ⑤ The duodenal ring is stagnant, and there is a straight impression on its inner edge; ⑥ Abdominal plain film in supine position shows "transverse colon transection" sign, that is, the liver curvature and spleen curvature of colon expand, but even if the position is changed, the transverse colon does not expand, which is caused by colon spasm caused by acute pancreatitis. (2) Barium meal radiography of upper digestive tract: The following signs can be seen: ① The head of pancreas is enlarged and the duodenal ring is enlarged; ② Compression of gastric antrum; ③ Duodenal dilatation and congestion; ④ The enlargement of pancreatic head causes duodenal papilla edema or inverted "3" sign; ⑤ When pancreatic pseudocyst occurs, the gastrointestinal tract is squeezed. Abdominal plain film of chronic pancreatitis (1): pancreatic stones and calcified shadows can be seen; (2) Barium meal in upper digestive tract: oppression or obstructive changes can be seen; (3)ERCP: It can be seen that the main pancreatic duct has localized dilatation, stenosis, or beaded changes with irregular wall. Sometimes the lumen is occluded, and stones or pancreatic ducts are cystic. According to the diameter of the main pancreatic duct, chronic pancreatitis can be divided into large pancreatic duct (diameter 7mm) and pancreatic duct (diameter ≤3mm). The former is suitable for drainage surgery, while the latter requires pancreatectomy in different ranges. 2. Ultrasound examination of pancreatic volume increase in acute pancreatitis (1): In edematous pancreatitis, pancreatic volume increase is rare; In severe pancreatitis, it is often swollen, and the outline of the pancreas is vague, the surface is not smooth, the boundary between the deep side of the pancreas and the splenic vein is unclear, and sometimes the boundary between the front and back of the pancreas is difficult to distinguish. (2) Pancreatic echo enhancement: In edematous pancreatitis, part of the echo of the pancreas is enhanced, but in severe pancreatitis, the inside of the pancreas is extremely uneven, with strong echo and irregular hypoechoic area. (3) Abdominal effusion: rare in edematous pancreatitis, but common in severe pancreatitis, mostly diffuse or localized effusion around the pancreas. Pancreatic abscess and pseudocyst can also be found after treatment. Chronic pancreatitis can be manifested as pancreatic pseudocyst, pancreatic duct dilatation and pancreatic malformation, and can prompt complex biliary diseases. According to the above, combined with clinical characteristics, ultrasound can be used as one of the means to distinguish edema from severe pancreatitis. 3.CT scan can also show various pathological changes of the pancreas and its surrounding tissues, from mild edema and bleeding to necrosis and suppuration. CT can also find hydrops around pancreas and edema of omentum and perirenal space, which is helpful for early detection and follow-up observation of pancreatic pseudocyst. Because it is not affected by gastrointestinal pneumatosis and obesity, it is an important diagnostic method of chronic pancreatitis, which can clearly show the gross pathological changes of most cases. According to the CT findings of chronic pancreatitis combined with B-ultrasound, the imaging changes of chronic pancreatitis can be divided into the following types: ① mass type: the pancreas is locally enlarged, forming a well-defined and regular mass, and enhanced CT scan can show uniform enhancement effect without obvious bile duct and pancreatic duct dilatation; ② Mass plus bile duct dilatation: besides the mass, it is accompanied by bile duct dilatation; ③ Diffuse swelling: the pancreas was diffuse swelling, with no definite mass and no obvious expansion of pancreatic duct; ④ Dilated pancreaticobiliary duct type: double dilatation of pancreaticobiliary duct with no obvious mass at the head of pancreas; ⑤ Dilation of pancreatic duct: It shows that the pancreatic duct is dilated all the time. In addition, pancreatic calcification, pancreatic duct stones and pancreatic cysts can be seen. The above classification is helpful to guide the choice of surgical operation. 4. Fiberoptic gastroscopy (1) has no direct diagnostic value. It can be seen that the gastroduodenal mucosa is edema and congestion, and convex changes can be seen in the posterior wall of the stomach (caused by enlarged pancreas). (2) Fiberoptic duodenoscopy can not only observe the pathological changes of gastroduodenal mucosa, but also observe the abnormalities or pathological changes of duodenal papilla, especially in pancreatitis caused by incarcerated ampulla stones, and can directly find the cause. (3) Endoscopic retrograde cholangiopancreatography (ERCP): It is only suitable for understanding biliary diseases after acute symptoms are controlled. Although pancreatic duct obstruction can also be judged, it may lead to pancreatitis recurrence and become injection pancreatitis, so it is not suitable for routine use. 5. Laparoscopy has certain significance for acute epigastric pain or severe pancreatitis with unclear diagnosis. A series of pathological changes can be seen through laparoscopy, which can be divided into accurate signs and relative signs. 6. Angiography Angiography can show vascular diseases (such as aneurysms and pseudoaneurysms) in the pancreas and pancreatic peripheral arteries. 7. Radionuclide scanning is normal in the early stage of onset, but in severe pancreatitis, uneven or undeveloped or localized radioactive defect areas can be seen. 8. MRI of chronic pancreatitis showed localized or diffuse enlargement of pancreas, and T 1 weighted images showed mixed low signal; The weighted image shows mixed high signal. It is difficult to distinguish chronic pancreatitis from pancreatic cancer in MRI examination. 9. Other examination methods, such as ECG and EEG, are not directly helpful for the diagnosis of this disease, but they have changed greatly in severe pancreatitis, and can be used as auxiliary examination methods for diagnosis and treatment. Information about other related diseases of pancreatitis: 6? 1 What causes pancreatitis? ? 6? 1 ? 6? 1 What diseases is pancreatitis easily confused with? ? 6? 1 What are the manifestations of pancreatitis and how to diagnose it? ? 6? 1 How should pancreatitis be treated? ? 6? 1 What diseases can pancreatitis complicate? ? 6? 1 How to prevent and care for pancreatitis?