Pancreatitis: Diagnosis

Initial laboratory studies include complete blood count (CBC), liver function tests, blood alcohol level, amylase, lipase, and lipid panel. Radiographic scans also play an important role. 

Lipase and amylase are generally elevated in acute pancreatitis, although the degrees of elevation do not correlate with disease severity. In chronic pancreatitis, lipase and amylase are usually not elevated.

Hypokalemia, hypocalcemia, and leukocytosis are often present in acute disease.

Elevated liver enzymes, bilirubin, and LDH may be present, especially if biliary disease is the etiology of pancreatitis. Liver enzymes may also be elevated due to compression of the common bile duct by an edematous pancreatic head.

Hypertriglyceridemia (>1000) may be the cause of pancreatitis in a small number of cases.

Patients are often hypoxemic, especially in severe disease.

Abdominal films, CT scan, and ultrasound evaluate for gallstone–related blockages, pancreatic necrosis or edema, and abscess or pseudocyst formation, and rule out nonpancreatic etiologies of abdominal pain.

Endoscopic retrograde cholangiopancreatography (ERCP) reveals the structure of the common bile duct and pancreatic duct and can be used to repair strictures and remove gallstones. However, many specialists are now using magnetic resonance cholangiopancreatography (MRCP) or endoscopic ultrasound more commonly than ERCP.