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More than just Tummy Ache

"Diagnosing pancreatitis"
By: Stef dela Cruz, MDMore than just Tummy Ache

Dull abdominal pain usually describes pancreatitis, which is inflammation of the pancreas. A person with manifestations of pancreatitis should undergo lab tests to confirm the diagnosis and help determine the cause.

Serum amylase or lipase determination can help gauge the length of time that inflammation has been doing its damage. Since the pancreas produces amylase and lipase, two enzymes that help in food breakdown, pancreatic dysfunction can lead to abnormal amylase and lipase levels.

In chronic pancreatitis, levels are only slightly high to normal—the pancreas may have already suffered enough tissue damage that it can no longer produce enough enzymes. On the other hand, in acute pancreatitis, amylase and lipase levels can be quite high.

Cholangiopancreatography, the visualization of the biliary tree and pancreatic ductal system, can be done via endoscopy or even magnetic resonance imaging (MRI). Ultrasound testing may also reveal the presence of cysts, calcified structures, and other changes pointing to pancreatitis.

However, imaging studies are usually not necessary. These tests may be requested for specific reasons, such as if a severe type of pancreatitis is suspected. When the diagnosis is still unsure despite lab tests, imaging tests can help show morphologic changes that confirm the presence of inflammation.

Testing for fats in stools can help support a diagnosis of pancreatitis, but fat malabsorption starts only after more than 90 percent of the pancreas has been damaged. Therefore, the absence of fatty stools does not necessarily rule out pancreatitis, especially in its early stages.

Other tests that can aid diagnosis include pancreatic function tests, endoscopic procedures, and fluid aspiration (if fluid accumulation is present). Aspirated fluids may be tested for the presence of bacteria, which helps differentiate between sterile and infected pancreatitis.

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