Pancreatitis. Symptoms, Tests. Decoding the results. Blood tests for pancreatitis: changes in indicators Instrumental diagnostic methods

Tests for pancreatitis– the most important stage in diagnosing the condition of the pancreas. Making a diagnosis is a labor-intensive process. Similar symptoms add confusion to the clinical picture. To reliably find out about the well-being of an organ, you need to donate urine, feces and blood, undergo an ultrasound, etc. The article highlights the key points of diagnosis: a list of tests with an interpretation of the results.

Pancreatitis: what tests need to be taken?

woman working on a microscope Eine Anwenderin sitzt an dem Mikroskop

The inflammatory process that progresses in many cases is accompanied by symptoms that can easily be attributed to workload, fatigue, or lack of sleep. Weakness, fatigue, weight loss, disruptions in work digestive system– all this accompanies the everyday life of metropolitan residents who snack on the fly, drink coffee on an empty stomach, get little rest and spend a lot of time on the road.

Diagnosis of pancreatitis includes blood tests , feces, urine. The insidiousness lies in the fact that the gland can tolerate bad habits, neglect of meals, stress, but one day it “explodes” and reminds itself of itself with an acute attack. Having suppressed severe pain, you will never return to your previous lifestyle. From then on, medications will become your eternal companions. Any departure from the diet will result in new attacks or, even worse, severe complications.

What tests need to be taken for pancreatitis?Firstly? As a rule, when contacting a specialist, the patient receives a number of referrals to a research laboratory. Depending on the results obtained, the doctor already decides whether a more in-depth examination is necessary and is based on the individual aspects of each patient. The above tests are mandatory, and more complex studies (MRI, ultrasound, etc.) are prescribed later, if necessary.

Blood test for pancreatitis: indicators and their meaning

A general clinical blood test allows one to suspect inflammation in the gland. However, making a diagnosis solely from its results is wrong.

In case of pancreatitis, a blood test shows:

Decreased red blood cells;

Decline of hemoglobin;

Increase in ESR;

Increased number of leukocytes many times over;

Increased hematocrit.

Blood counts for pancreatitischange up or down. Normally, these criteria are:

Red blood cells in men – from 3.9*10 12 to 5.5*10 12, in women – 3.9*10 12 to 4.7*10 12 cells/l.

Hemoglobin in men is from 135 to 160, in women – from 120 to 140 g/l.

ESR in men is from 0 to 15, in women – from 0 to 20 mm/h.

Leukocytes in men and women – from 4 to 9 * 10 9 liter.

Hematocrit in men is from 0.44 to 0.48, in women from 0.36 to 0.43 l/l.

Clinical blood test for pancreatitis- This is an auxiliary measure. For reliable diagnosis, it can be re-prescribed. Naturally, attention is paid to other research methods, which will be discussed below.

Biochemical blood test for pancreatitis

The well-being of the whole organism is clearly visible when taking a biochemical blood test. During the inflammatory process, the following indicators deviate from the norm:

Pancreatic amylase– the pancreatic enzyme responsible for the breakdown of starch increases.

Other representatives of the enzyme group, such as trypsin, elastase, phospholipase, and lipase, also increase.

Insufficient insulin synthesis causes an increase in serum glucose.

Bilirubin changes more than normal if a swollen gland blocks the bile ducts.

In some cases, transaminases increase.

Total protein decreases.

Elevated amylase – primary sign with pancreatitis in its chronic or acute manifestation. This enzyme helps break down carbohydrates. Lipase is responsible for the breakdown of fats. Trypsin and elastase are representatives of a group of proteases whose function is to cleave the peptide bonds of amino acids in proteins.

Biochemistry for pancreatitis is done within 24 hours from the day the patient is delivered to medical institution during an acute attack. During hospitalization, the dynamics of amylase are studied, preventing further attacks and complications. The doctor is informed about this by its continuing increase, coupled with severe pain.

What tests are taken for pancreatitis and cholecystitis? more?

The doctor may recommend other tests, for example, to determine immunoreactive trypsin in the blood serum. Only in 4 out of 10 cases will a positive result indicate damage to the pancreas. In others - that the violations affected other organs ( renal failure, cholecystitis, hypercortisolism, etc.). Blood concentrations of trypsin inhibitors are anotherblood test for pancreatitis , which shows the degree of gland dysfunction. How less number inhibitors, the less favorable the prognosis.

Urinalysis for pancreatitisrarely prescribed due to its cost. It is not the common common one that is informative, but the one that determines the presence of trypsinogen in the urine. Trypsinogen is a proenzyme that is an inactive form of trypsin. Its content in urine reliably confirms the inflammatory process.

Malfunctions in the digestive system will certainly affect the stool, so they resort to a stool test. Attention is paid to such criteria as:

Is there fat in the stool?

What is its color;

Are there any undigested food fragments?

All this indicates problems in the digestive system, and discolored stool means that the bile ducts are blocked. When inflamed, feces are poorly washed off the walls of the toilet. Due to excess fat, it has a shiny surface. Its consistency is liquid, the urge to defecate is frequent. Defecation is accompanied by a sharp and unpleasant odor.

Now you know,how to determine pancreatitis using tests. However, it is better to leave this responsibility to your attending physician, who, with his professionalism and medical knowledge, will not only make the correct diagnosis, but also correctly draw up a treatment regimen.

Drug release options and treatment features

The pharmacy chain offers several options for Almagel suspension, which differ from each other only in some components, giving them additional medicinal properties.

Almagel in green packaging (basic version).
Almagel A in yellow packaging.
Almagel Neo in red packaging.

All types of Almagel suspensions are available in 170 ml bottles.

How to take Almagel for pancreatitis? Features of Almagel therapy depend on what type of medication was prescribed to the patient.

The therapeutic effect of each variation of the suspension is directly related to the active components that are present in them.

Almagel. Prescribed for minor pain and little gas formation.
Almagel A. Recommended for painful discomfort that is more pronounced.
Almagel Neo. Prescribed for flatulence and excessive gas formation.

Use of the drug

Sugar level

Treatment with Almagel for pancreatitis also depends on the form of the drug. The medicine in yellow and green packaging must be shaken well before use to obtain a homogeneous composition. For pancreatitis, the drug should be taken 30 minutes before meals, in the evening before going to bed. Since the drug has only a temporary effect, the pancreas must be prepared for food intake. The suspension should be drunk without drinking water.

If the patient is simultaneously taking other medications, then it is important to maintain the required interval, at least 1 hour, between medications. However, if the doctor prescribed digestive enzymes for better digestion of food, then they can be taken after 30-40 minutes of using Almagel during meals

These are medicines such as:

However, if the doctor prescribed digestive enzymes for better digestion of food, then they can be taken after 30-40 minutes of using Almagel during meals. These are medicines such as:

Mezim forte;
Festal;
Creon.

The usual dosage of Almagel is from 1 to 3 measuring spoons up to 4 times a day, depending on the severity of the disease. A measuring spoon is equal to the volume of a teaspoon. After the patient’s well-being has returned to normal, the medicine should be taken 1 spoon three times for 3 months. Long-term use of Almagel involves the simultaneous use of phosphorus preparations. If the patient's condition requires a large dosage, then the duration of treatment should not exceed 14 days. If the patient is to reduce pain syndrome takes Almagel A, then after eliminating the symptoms you should switch to a product that does not contain an anesthetic.

Before taking Almagel Neo, you also need to shake it well. This suspension should be used 60 minutes after eating. Since this form contains alcohol, it should not be used by people suffering from epilepsy, liver and kidney diseases, alcoholism, or pregnant women. This drug is taken 2 spoons up to 4 times a day. Moreover, the daily dosage should not exceed 12 spoons. Almagel T is usually prescribed 2 tablets up to 6 times a day, depending on the severity of the disease. Typically, this form is taken 1 hour before meals, with a therapeutic course of 14 days.

This drug can reduce the effectiveness of treatment with tetracyclines, cephalosporins, antihistamines, and Indomethacin. During pregnancy, therapy with Almagel should not exceed 3 days; it excellently fights nausea. During breastfeeding, this drug is prohibited for use, because breast milk it can get to the baby and lead to hypermagnesemia.

Almagel is a good remedy for the treatment of pancreatitis, however, to avoid the development of side effects, you should always consult with your doctor before starting to take it.

Almagel for gastritis when and how to take

Gastritis is a stomach disease with very unpleasant symptoms, the manifestation of which every patient who has encountered them wants to reduce.

Medicines that neutralize the symptoms of gastritis should have a mild effect and not cause side effects. The optimal drugs are those that show their effect over a fairly long period of time.

An important nuance in this case is the ratio of price and quality. One of the drugs recommended by gastroenterologists for stomach diseases is Almagel.

Description of the drug

Almagel - among antacids

The main accompanying processes of gastritis are increased secretion gastric juice and sensitivity of the mucous walls of the organ. As a result, pain appears, a feeling of heaviness after eating and other unpleasant symptoms.

Almagel is a common drug from the category of antacids intended to neutralize gastric juice. Its main active ingredients are sorbitol and magnesium and aluminum hydroxides. Benzocaine or anesthesin is added to Almagel A.

The drug contains additional substances:

distilled water;
saccharin;
lemon oil;
ethanol;
sorbitol, etc.

Almagel reduces production for a long time of hydrochloric acid in the stomach and neutralizes the destructive effects of gastric juice on the walls of the diseased organ, without reducing the acidity of the internal environment.

The active elements of the drug exhibit a slight choleretic and laxative effect. The pain syndrome is reduced due to the local anesthetic effect of the drug.

Almagel prevents repeated emissions of hydrochloric acid, does not provoke flatulence and the formation of stones in the urinary system.

The product is available in bottles in the form of a gel suspension. This shape ensures uniform and maximum distribution active ingredients along the walls of the stomach, which enhances the therapeutic effect.

Features of use for gastritis

Almagel - suspension

A special feature of the drug is the formation of a small layer of liquid on the surface of the suspension. In order to return the composition to homogeneity, you need to vigorously shake the bottle several times.

The dosage for children over 15 years of age and adults is 1-2 measuring spoons (included with the suspension) - 5-10 ml. Appointments are scheduled 3-4 times a day. If indicated, the dose is increased to 3 scoops (15 ml). The course of such treatment is 4-7 days or until you feel better.

For children aged 10 to 15 years, the daily dose is 2.5 ml (half a scoop) 3-4 times a day. Almagel should not be taken with liquid or eaten within 15 minutes following taking the medicine.

If you want to reduce the irritation of another medicinal product, Almagel take 1-3 measuring spoons 15 minutes before use.

The difference in taking Almagel and drugs whose effectiveness it reduces should be 2-2.5 hours. Before using the drug, consultation with a specialist is required.

Types of drug

Almagel is presented in different forms on the pharmaceutical market:

Almagel “green” consists of Magnesium Hydroxide, Aluminum Hydroxide, which have a neutralizing effect on hydrochloric acid by converting it into water and salt, thus blocking its production and splashing into the stomach. The effect on pepsin occurs in a similar way. In addition, this drug envelops the stomach, thereby protecting it from irritation. Excellent for people suffering from temporary heartburn to eliminate unpleasant symptoms.
Almagel A has a yellow package, is used for more serious symptoms of pancreatitis, helps relieve pain, as it contains an analgesic. Benzocaine has a longer lasting analgesic effect and is not toxic.
Almagel Neo helps reduce gas formation, it resolves the formed bubbles, thereby relieving bloating.
Almagel T has a tablet form, is similar in action to Almagel, and is developed for those people who have difficulty tolerating the suspension.

pharmachologic effect

Almagel is an antacid medicines. Antacids are drugs that protect the mucous membrane of the gastrointestinal tract and pancreas. The main pharmacological effect of Almagel is the formation of a kind of shield around the mucous membrane that does not allow access to the pancreas. harmful substances. The main ones on the list are bile and hydrochloric acid. With pancreatitis, the supply of bile is disrupted, hence, counteraction to the secretion of the gallbladder is necessary.

You need to take this product to achieve your goals:

neutralization of hydrochloric acid secreted by the stomach;
decreased activity of the body’s digestive processes;
decreased activity of the enzyme pepsin, which affects digestion;
absorption and neutralization of harmful substances.

Almagel does not completely simplify the patient’s life, but the benefits of the drug are obvious. The effect of taking the suspension will not occur instantly, however clinical researches admit that the drug allows one to achieve a certain therapeutic success.

How to take it?

The main principle of action of Almagel, like any antacid, is the protection of the mucous membrane. This protection is short-lived, the effect of the drug is temporary and does not begin immediately after administration.

You need to take the medicine in advance, before potential irritation of the pancreas. Doctors recommend diluting the suspension half an hour before meals. After taking the medicine and waiting for it to take effect, you can start eating, simultaneously taking medications to digest the food. These include:

An hour after eating, you need to drink the medicine selected from the list:

When taking medication, it is important to drink plenty of boiled or filtered water. Water is extremely beneficial for patients with pancreatitis, it removes harmful substances from the body

The last three drugs are used to restore intestinal microflora, and, when taken along with Almagel, beneficial features quite noticeable. Without the drug, other protective actions against pancreatitis are simply useless; taking Almagel is mandatory.

Self-prescription of drugs is unacceptable. Self-medication for pancreatitis is the worst possible solutions, it is better not to take risks, let the patient’s education and level of knowledge allow him to determine the effect of the product on the pancreas.

Almagel A in the treatment of disease

Almagel A for pancreatitis differs from the previous version in that it contains an analgesic (benzocaine), therefore, in addition to the main medicinal characteristics, it also has an analgesic effect. This medication option is prescribed to patients who experience severe pain.

The dosage is similar to the basic version of Almagel. However, the duration of treatment with Almagel A is 1 week, then you need to switch to Almagel.

Contraindications are the same as for the main Almagel. True, there are also individual contraindications, for example, Almagel A cannot be taken simultaneously with sulfonamide medications.

It can be prescribed to pregnant women, but the maximum period of its use is no more than 3 days.

Biochemistry for pancreatitis is highly diagnostic. This is due to the fact that the activity of enzymes that enter it during inflammation is determined in the blood.

Biochemical research includes a number of criteria

A biochemical blood test for pancreatitis is an important test, which is prescribed for a reliable diagnosis of the inflammatory condition. It implies a definition wide range indicators that, to varying degrees, indicate the severity and nature of the process.

For ease of deciphering, the studies were divided into 2 conditional groups:

straight - change only with pancreatic pathology;
indirect – changes are associated with diseases of other digestive organs, in particular the liver and hollow structures of the hepatobiliary tract (PSGT).

Direct or indirect changes in the pancreas in biochemistry are examined privately by a gastroenterologist or therapist (depending on the results of other studies, including a survey and examination).

DIRECT INDICATORS

Direct indicators of biochemical research for diagnosis pathological conditions pancreas include the concentration of certain organic compounds in plasma or enzyme activity:

Total protein. The concentration of all protein compounds in plasma directly depends on the functional activity of the exocrine part of the organ.
Amylase is an enzyme produced by the glandular cells of the pancreas and is responsible for the digestion of carbohydrates in the lumen small intestine. An increase in its activity indicates damage to the glandular cells, and the compound does not enter the ducts of the organ, but directly into the plasma.
Lipase is also an enzyme that, together with bile acids, is responsible for the digestion of fats. After cell damage, increased plasma lipase activity persists for a long time, which can be an important diagnostic criterion.
Glucose is the main carbohydrate in the human body, which supplies the necessary energy during biochemical transformations. An increase in the level of an organic compound is evidence of possible pathologies of the intrasecretory part of the organ with impaired production of insulin (the hormone that is responsible for the absorption of glucose by tissues and a decrease in its concentration in the blood).
Serum elastase is an enzyme whose increased activity is direct evidence of tissue necrosis (death) due to the development of the disease.

Changes in direct criteria in the analysis make it possible to judge changes functional state and the work of the exocrine part of the gastrointestinal tract structure. increase due to severe damage to glandular cells.

Attention! The cause of inflammation is determined during a comprehensive diagnosis, including other methods.

INDIRECT INDICATORS

Changes in indirect indicators are an important diagnostic criterion that allows one to determine the pathology of other structures of the system:

Total, direct and indirect bilirubin – organic compound, which is produced by the liver and belongs to the final products of hemoglobin metabolism. If bilirubin is increased during pancreatitis, this is evidence of edema, leading to compression of the common bile duct and impaired excretion of the component with bile.
Gamma-glutamyl transpeptidase (GGTP). Its activity increases with the development of congestion in the structures of the hepatobiliary tract with a violation of the secretion of bile into the lumen of the duodenum.
Alkaline phosphatase becomes more active in a similar way to GGTP, but the increase occurs more slowly.
Liver transaminases (AST and ALT). Their increase is an indicator of hepatocyte damage, which can occur due to various reasons.

For biochemistry, material is taken from a vein

An increase in values in most cases is a manifestation of tissue edema, leading to compression of PSGT, stagnation of bile and partial damage to liver cells.

Normal values

Normal direct and indirect values of biochemical analysis

Compound	Normal value	Units
Glucose	3,3-5,5	mmol/l
Total protein	65-85	g/l
Amylase	Up to 64	Units
Lipase	Up to 190	Units
Serum elastase	0,1-4	ng/ml
Total bilirubin	8,4-20,5	µmol/l
Direct bilirubin	2,2-5,1	µmol/l
Indirect bilirubin	8,6	µmol/l
GGTP	33,5-48,6	Units
Alkaline phosphatase	Up to 260	Units
ALT	0-38	Units
AST	0-44	Units

Biochemistry for acute pancreatitis

Acute inflammation is characterized by cell and tissue damage that develops over a relatively short period of time. In this case, damage and “self-digestion” of tissues often occur with the release of molecules into the plasma. The assay significantly increases the activity of amylase and elastase. The remaining indicators usually do not yet have time to change, but provided that there is no other chronic pathology of the digestive system at the time of development acute inflammation.

Attention! Acute period is dangerous condition: Digestive enzymes can cause critical decline blood pressure and multiple organ failure.

Biochemistry in chronic inflammation

The chronic process takes a long time to develop, but the severity of the changes remains at a low level. In the analysis, attention is drawn to an increase in lipase and glucose, and a possible decrease in the concentration of total protein. Since a chronic inflammatory process can occur with edema, an increase in indirect criteria for the disease in a biochemical study is not uncommon.

Since the biochemical test for pancreatitis is informative method objective diagnosis, the study is always prescribed if there is a suspicion of diseases not only of the pancreas, but also of other components of digestion.

Indicators for different phases of pancreatitis

A biochemical blood test can confirm acute pancreatitis. The disease has three successive phases:

Enzymatic, when there is massive inflammation of the gland with the release of enzymes into the blood. In the first days of the disease, pancreatic amylase in the blood will be increased 3-5 times (the norm is up to 50 U/l), and the concentration of lipase will also increase (the standard is less than 10 U/l). The values of elastase, trypsin, and glucose will increase.
Intermediate, reactive, which lasts from five days to two weeks. During this period, biochemical markers will also be elevated. Fluctuations in the values of amylase and lipase are characteristic; the level of total protein is often reduced (less than 65 g/l).
Late phase with the formation of septic or aseptic sequestra (dead areas of gland tissue). With adequate therapy during this period, all indicators will have increased values, but subsequently will gradually decrease to upper limits norms.

It is difficult to determine the stage of acute pancreatitis based on the level of lipase, alpha-amylase or trypsin. These indicators best indicate the severity of the process. Long-lasting hyperamylasemia indicates ongoing necrosis of organ tissue.

Answers on questions

WHAT DOES AN INCREASED GGTP IN BLOOD BIOCHEMISTRY SAY? ANDREY 45 YEARS OLD, ULAN-UDE

Hello! In 2005, he underwent surgery and had his gallbladder removed. Today for ultrasound diffuse changes pancreas and liver. I donated blood for biochemistry: all indicators are normal, except for GGTP - 126 (with acceptable levels of up to 55). I don’t drink, don’t smoke, height 180 cm, weight 65 kg. I take medications Sotahexal, Propanorm, Atorvastatin, Fish fat Omega-3, linseed oil, Essentuki water, Asparkam, Duspatalin, Nolpazu. I am concerned about this increase in GGTP. What should I pay attention to and what do you recommend? Thank you in advance.

Hello Andrei!

An increase in GGTP indicates the likelihood of bile stagnation in the passages, which is associated with a disorder in the liver cells themselves. That is, we are talking about intrahepatic cholestasis. And the level of GGTP is indeed significantly increased.

It is recommended, first of all, to consult a therapist or cardiologist whose prescription you are taking Atorvastatin (taking into account Sotohexal, I assume that this is due to cardiovascular system). There is such by-effect Atorvastatin.

Please note that it is not recommended to cancel or reduce the dose of the drug without consulting a doctor, because this is fraught with a sharp increase in cholesterol and other indicators of lipid metabolism.

Ursodeoxycholic acid preparations (Ursofalk, Ursosan) are very good for intrahepatic cholestasis (and taking into account ultrasound data). The dose and duration of the drug can only be determined by your attending physician, who knows both you and your medical history.

Clinical signs of pancreatic inflammation are difficult to distinguish from other diseases digestive tract, they all cause similar symptoms: abdominal pain, dyspepsia. In this case, blood tests for pancreatitis play a major role. Other tests, for example, examination of stool, saliva, and urine, determine the form of pancreatitis - acute or chronic. For a doctor treating pancreatitis, you need to know exactly whether you are dealing with an acute form of the disease or an exacerbation of a chronic one. inflammatory process in iron.

The pancreas breaks down proteins, fats and carbohydrates, and also synthesizes the hormone insulin, which delivers glucose to the body's cells. Diagnosis of pancreatitis involves determining the concentration of digestive enzymes and gland hormones in bloodstream.

Amylase – is involved in the processing of carbohydrate foods (breaks down starch); A distinction is made between pancreatic amylase and general α-amylase (diastase).
Trypsin and elastase– ensure the absorption of proteins.
Lipase - breaks down fats; its deficiency is detected by an increase in cholesterol in tests.

Lack of insulin leads to increased sugar in the bloodstream.

Pancreatic enzymes normally become active only in the intestines. If the movement of pancreatic juice through the ducts to the intestines is difficult, some enzymes are activated in the organ itself, “digesting” it - an inflammatory process occurs. It can be sluggish, proceed without pain, but is accompanied by degeneration of organ tissues, which are deprived of secretory activity. Tests for chronic pancreatitis reveal pathological processes and functional pancreatic insufficiency. If chronic pancreatitis is suspected, diagnosis includes the following laboratory tests;

Complete blood count (CBC) – detects inflammation in the body;
Biochemical analysis is the most important diagnostic test for pancreatitis – provides information on the content of digestive enzymes, as well as glucose and cholesterol in the blood.
Urine analysis for diastase - may show a slight but prolonged excess of amylase in the urine - a sign of chronic pancreatitis; a decrease in amylase compared to the norm indicates degeneration of the gland tissue.
: fat feces grayish color with undigested food remains indicate a dysfunction of the pancreas.
Testing saliva for amylase levels will help differentiate acute from chronic inflammation.

Member of the organization proper nutrition and taking medications that correct secretory organ failure. Sick people quickly understand. As soon as you break your diet for pancreatitis, after a few hours a painful attack begins, which must be distinguished from an acute form of inflammation of the pancreas.

Diagnosis of acute pancreatitis

In acute inflammation, there is intense destruction of gland tissue by its own enzymes, which is accompanied by poisoning and deterioration general condition body. Diagnosis of pancreatitis in its acute form begins with taking into account clinical manifestations. The main symptom is pancreatic colic - sharp pain in the epigastric region, it can be so strong that the patient loses consciousness.

The pain syndrome is aggravated by attacks of vomiting that do not bring relief. In such a situation, doctors prescribe tests that are necessary to establish the fact of inflammation in the body and assess the extent of damage to the gland. Standard tests for pancreatitis are marked “cito!”, and should be done as quickly as possible:

general analysis blood (BAC);
blood biochemistry - characterized by a sharp increase in amylase content in the blood, since with such a pathology it is activated not in the intestines, but in the pancreas itself and enters the bloodstream;
urine shows an increase in diastase sometimes 200-250 times; to monitor the dynamics of acute inflammation, urine should be taken every three hours;
stool analysis acute pancreatitis may indicate that the process of digesting food is disrupted.

An increase in amylase in the blood is also characteristic of such pathologies as cholecystitis, diabetes mellitus, and pain syndrome of the “ acute abdomen"may indicate appendicitis, perforated ulcers and other diseases abdominal cavity. To clarify pancreatitis it is necessary differential diagnosis. Before recognizing acute inflammation, the pancreas is examined by others, MRI, radiography, to determine the localization of the pathology, its nature (inflammation, cyst, tumor).

Blood tests

Informative tests for pancreatitis are a blood test: blood is taken from a finger for a general analysis; from a vein - for biochemical.

General analysis

Data from a general analysis show the presence of an inflammatory process in the body. In acute pancreatitis, the blood formula changes significantly.

The number of leukocytes sometimes increases tens of times. Normally, the leukocyte content is no more than 9∙109/l.
The erythrocyte sedimentation rate (ESR) increases, its normal value is 15-20 mm/h.
The hematocrit (the ratio of the volume of red blood cells and plasma) increases, the blood becomes thick due to an imbalance of water-salt balance and fluid loss. The normal hematocrit is 46-48%.

With chronic inflammation of the pancreas, the following changes are noted in a blood test:

the number of white blood cells sometimes even decreases, but usually there is a slight increase over a long period of time;
ESR slows down;
there is a decrease in hemoglobin levels - which indicates developing anemia against the background of exhaustion of the body. Normal hemoglobin level is 120-160 g/l

Blood biochemistry

During a biochemical blood test for pancreatitis, attention is paid to the following data:

the level of enzymes produced by the pancreas: diastase, lipase, trypsin;
glucose content;
amount of proteins acute phase inflammation (globulins, C-reactive protein);
total protein concentration.

Complications in the development of pancreatitis are indicated in a blood test by low calcium levels, the appearance of tumor markers, and an increase in glycosylated hemoglobin.

Pancreatic enzymes

When the pancreas becomes inflamed, its cells are destroyed, the enzymes that were in them enter the blood - their level increases sharply, which indicates the activity of the inflammatory process.

Amylase

The most characteristic sign of pancreatitis is a jump in amylase in the blood. At the very beginning of acute pancreatitis and in the first hours of relapses of a chronic disease, fast growth pancreatic amylase in the bloodstream. Maximum value this indicator reaches the end of the first day, then it decreases, and on days 4-5 it gradually returns to normal.

It should be noted that the value of total amylase (diastase) does not always indicate the development of pancreatitis. This enzyme is produced by both the pancreas (P-type) and salivary glands(S-type). An increase in α-amylase with normal P-type levels is not a sign of pancreatitis. At chronic form disease, sometimes there is even a decrease in the enzyme in the blood, which may indicate deep damage to the gland cells that produce this secretion.

Lipase

As part of pancreatic juice, lipase enters the intestine, where it promotes the breakdown of dietary fats. Its content in the blood should be 20 thousand times less than in pancreatic juice. An increase in the level of lipase in the bloodstream - hyperlipasemia - means that fatty food in the intestine it is not completely digested, this leads to an increased level of cholesterol in the blood, as well as to changes in stool. Both of these signs, combined with an increase in lipase in the blood, make it possible to diagnose pancreatitis and other pathologies of the pancreas. The level of lipase in acute pancreatitis begins to increase on the second day from the onset of inflammation and remains at a height of 1.5-2 weeks, exceeding the norm by 5-10 times.

Currently, a radioimmunological method has been developed for the determination of trypsin and phospholipase in blood serum. With exacerbation of pancreatitis, phospholipase activation increases tens and even hundreds of times (at a norm of 2-7.9 ng/l, it reaches 400 ng/l). A low level of lipase indicates damage to gland cells that synthesize enzymes.

Proteases: trypsin and elastase

Proteases break down protein foods in the intestines; when the pancreatic ducts are disrupted, they enter the bloodstream instead of the digestive tract.

The content of trypsin in the blood at acute forms pancreatitis increases compared to the norm by 12-70 times - on the first day of illness, and then quickly decreases to normal levels. Chronic course the disease is accompanied low level trypsin (2-10 times lower than normal), which is an indicator of the death of gland cells secreting enzymes.
Elastase is an enzyme that, in acute pancreatitis, rests on high level within 7-10 days of illness. At this time, in many patients, the content of lipase and amylase already returns to normal, but the amount of elastase remains significant in 100% of patients with pancreatitis. The higher the concentration of elastase in the blood, the more iron is affected by inflammation, the larger the area of necrosis and the worse the prognosis of the disease. In chronic pancreatitis, diagnosis is carried out by the elastase content in the stool; its low content indicates a weakened ability of the gland to synthesize digestive enzymes.

Glucose level

If inflammation engulfs the endocrine cells of the gland that synthesize insulin, against the background of its deficiency, an increase in blood sugar occurs. Without insulin, glucose cannot be absorbed by the body's cells. The glucose level is very important, since diabetes is one of the common complications of pancreatitis. A more accurate indicator is glycated (glucose-bound) hemoglobin, which gives an idea of the blood sugar level over three months.

With pancreatitis, the protein content in the blood changes.

The amount of acute phase proteins (C-reactive protein, fibrinogen) increases - they appear in the blood during any inflammatory processes. With successful relief of inflammation, their number decreases.
The concentration of total protein and albumin decreases - this is associated with indigestion: food entering the intestines is not completely digested due to , is not absorbed into the blood, but leaves the body with fecal residues. This indicator is especially characteristic for chronic pancreatitis.

Other indicators

IN in some cases Other indicators are used to diagnose pancreatitis.

With inflammation of the pancreas, the concentration of the enzymes ALT (alanine aminotransferase) and AST (aspartate aminotransferase) increases. Normally, these compounds are inside cells, participating in protein metabolism. With pathological destruction of cells, enzymes enter the bloodstream. An increase in ALT and AST in the blood is a sign not only of pancreatitis, it also accompanies diseases of the liver, heart, and severe muscle injuries. In combination with other symptoms of pancreatic pathology, ALT and AST indicators are used to clarify the diagnosis. In acute pancreatitis, the concentration of AST exceeds the norm by 2-5 times, and the ALT enzyme - by 6-10 times.
Determination of tumor markers in the blood is prescribed to exclude severe complication pancreatitis – pancreatic cancer. Specific proteins for gland pathology are CA 19-9 and CEA (carcinoembryonic antigen), which are produced by degenerated cells. An increase in C 19-9 by three times and CEA by two times is a sign of pancreatitis; if these indicators are exceeded, they indicate the possible development of a malignant tumor in the gland. In some cases, a positive result for tumor markers indicates diseases of the liver, stomach, and not the pancreas.
An increase in bilirubin is observed in the case of an increase in the size of the inflamed pancreas, which impedes the outflow of enzymes from the gallbladder.

Analysis of urine

A biochemical urine test is informative in diagnosing pancreatitis. The color of urine becomes a sign of the disease: the light yellow color changes with inflammation to dark yellow or brown. In urine analysis, an increase in diastase is observed. The more active the inflammatory process, the sharper the rise. This indicator is characteristic not only of acute pancreatitis; amylase in the urine also increases in diabetes mellitus. Severe inflammation is accompanied by ketone bodies, leukocytes and red blood cells present in the urine. Protein is found in urine when its absorption in the intestine is impaired. urine must be taken repeatedly to control the dynamics of amylase in the body.

Urinalysis for chronic disease gland shows a decrease in the level of α-amylase, which is associated with a weakening of the secretory functions of the gland during long-term pathology.

Stool analysis

If you have symptoms of inflammation of the pancreas, you need to submit your stool for examination to clarify the diagnosis. To obtain reliable results, get tested after a dietary meal. You need to consume 105 g of protein food, 180 g of carbohydrate food, 135 g of fat. Stool analysis for pancreatitis provides information about functional disorders of the pancreas.

The increased fat content makes stool shiny, with a pasty consistency and high content fatty acids is evidence of a lack of the lipase enzyme in the intestines.
Changes in stool also affect its color: with pancreatitis, it acquires a grayish tint.
The presence of undigested residues indicates a general lack of enzymes in the intestines.
A decrease in the level of elastase-1 in the feces shows how much the secretory function of the pancreas is reduced. In severe cases, fecal elastase levels drop below 100 mcg/g.

Interpretation of biochemical analysis

The final formulation of the diagnosis is made on the basis of research: laboratory and instrumental. When diagnosing inflammation of the pancreas, the main thing is a blood test for pancreatitis; it gives indicators of abnormalities in pancreatic enzymes:

the level of pancreatic amylase in the blood should not exceed 54 units; with pancreatitis, it increases sharply on the first day of the disease;
normal lipase content is up to 1.60 units/l, with acute pancreatitis it increases 5-20 times;
The normal trypsin content is 10-60 μg/l, an increase indicates acute inflammation, a decrease indicates a chronic process.
The upper limit of normal elastase in the bloodstream is 4 ng/ml; the higher its excess, the more severe the form of the disease.

Laboratory examination provides other informative indicators.

The sugar content in the bloodstream should not exceed 5.5 mmol/l; with pancreatitis it increases.
Total protein content healthy people– 64 g/l, its decrease indicates pathology of the pancreas, lack of nutrition or intestinal diseases.
Protein norm CA 19-9 – up to 34 units/l; exceeding the level is a sign of pancreatitis, a significant increase is a suspicion of oncology.
The normal level of cholesterol in the blood is 6.7 mmol/l; in men its level is higher than in women. With diabetes mellitus and pancreatitis, cholesterol levels increase.
AST and ALT enzymes are normally up to 41 mmol/l; if the level is elevated, there is reason to diagnose pancreatitis.

With variety diagnostic methods and indicators that are informative for the attending physician are the value on the first day of the disease and the determination of lipase and elastase in subsequent days.

Is it possible to diagnose laboratory methods acute pancreatitis, if there are no typical symptoms? Is it possible to conduct a blood test for pancreatitis, the results of which will indicate the need for urgent hospitalization? What other research methods should be used if a general blood test or other laboratory parameters were not informative?

Spicy and chronic inflammation pancreatic tissue (páncreas) are the most common diseases of this organ, which lead to a significant deterioration in the quality of life, and often to the death of the patient. Death most often occurs due to massive pancreatic necrosis - necrosis of the gland, which is a vital organ.

Before moving on to what indicators determine an acute or chronic process in the gland tissue, it should be noted that, unfortunately, an alcohol history in patients will indicate a high risk of developing pancreatitis.

Most common cause acute pancreatitis is self-digestion, which in 90% of cases is associated with excessive and regular consumption of alcohol and the intake of fatty, spicy and smoked foods during the “feast”. Alcoholic drinks promote spasm of the sphincters of the excretory ducts; as a result, the secretion of the pancreas, which was sent to digest food entering the duodenum, is unable to get there and begins to digest the gland itself. The result is an attack of acute pancreatitis. But in some cases, in exhausted subjects, in persons in a state of acute alcoholic intoxication, and even in alcoholic coma, in the elderly, the typical picture of acute pain syndrome in the epigastrium may not be clearly expressed. And in this case, along with laparoscopy and imaging techniques (ultrasound) in surgical department To verify the diagnosis, blood tests are taken for pancreatitis. Which ones are the most informative?

How does acute and chronic pancreatitis manifest in blood tests?

It should be said right away that gastroenterologists mainly deal with chronic pancreatitis; their task is to ensure adequate digestion in case of insufficient absorption syndrome, and to prevent progression chronic process in acute, therefore the basis of treatment of chronic pancreatitis is, of course, diet and taking enzyme preparations.

As for the sudden and violent acute onset, here we are talking about a pure surgery clinic, where the patient is hospitalized by ambulance, and all blood tests for pancreatitis will be taken in the laboratory of a surgical hospital, most likely for cito, that is, urgently ok.

General blood analysis

Since the diagnosis of pancreatitis itself has the ending “-itis”, that is, it indicates the presence of an inflammatory process in the body, then in general, or in the very first blood test that is performed, in a typical case a clinical picture of a nonspecific inflammatory syndrome will arise. This will be evidenced, first of all, by changes in the composition of white blood, leukemia and an increase in the erythrocyte sedimentation rate.

If usually the number of leukocytes does not exceed 9∙109/l, then in the case of acute pancreatitis leukocytosis develops, which can exceed values of 15, 20 and even 30 -109/l. But the degree of leukocytosis depends on the form of acute pancreatitis. When it occurs regarding light form interstitial acute pancreatitis leukocytosis does not exceed 10-12, with possible . Typically, the norms of red blood parameters do not change in mild forms of acute pancreatitis. In the case of a necrotic form with necrosis of a significant amount of pancreatic tissue, leukocytosis increases faster and reaches values of 25 and higher, ESR increases to 30-40 and higher.

A typical shift of the leukocyte formula to the left appears, the number of band and young leukocytes that enter the peripheral blood from the depot and from the red bone marrow increases. Against this background, the percentage of neutrophils increases and the number of lymphocytes decreases, and lymphopenia develops.

In the event that purulent inflammation and melting of necrotic areas of the pancreas develops, then against the background of a significant worsening of the general condition, it appears. High leukocytosis with a neutrophilic shift remains, there are practically no lymphocytes in the peripheral blood, and in severe cases, a blood test shows how leukocytosis changes to leukopenia (the number of white blood cells falls).

In a biochemical blood test, an increase in the concentration of island phase proteins, primarily fibrinogen, decreases, its composition changes, and symptoms of a laboratory decrease in potassium and calcium levels appear.

Potassium is no longer synthesized by the kidneys in normal concentrations, and dangerous hyperkalemia occurs. A decrease in plasma calcium occurs due to the spread of fat necrosis. As a result of this process, free fatty acids are formed, which bind calcium. In turn, fatty acids appear in significant quantities because pancreatic lipase begins to work, and it destroys its own cells, and not fats in the intestinal lumen, as it should be normally.

But against this background, it is important to determine, even in the first hours of the onset of the disease, the presence of specific laboratory symptoms that are a sign of pancreatitis.

Biochemical blood test indicators

With classic acute pancreatitis, low-grade fever most often occurs; different indicators are given, but they may indicate bronchitis and tuberculosis, and other symptoms of inflammation. None of them are specific for pancreatitis. Therefore, it is much more important than a general blood test to pay attention to specific changes in biochemical analysis blood in pancreatitis:

A change in the pancreas also causes an increase in the concentration of trypsin, the enzyme lipase, the enzyme elastase and other enzymes in the peripheral blood. Diagnosis of acute pancreatitis assumes a direct relationship between the volume of the destroyed part of the gland and the release of its intracellular enzymes into the peripheral blood;
When turning off large quantity pancreatic parenchyma from the normal circulatory process there is a deficiency produced by islet cells, and therefore in acute pancreatitis, a blood test for the presence of sugar will show an increase in the concentration of glucose in the peripheral blood with the development of hyperglycemia;
The amount of diastase in the urine increases (this is what urine amylase is called), and its concentration also increases in various exudates and effusions in the abdominal cavity during the typical course of the disease;
In the event that there is pronounced swelling at the junction of the gland duct together with the common bile duct into the duodenum, then symptoms of obstructive jaundice appear and increase. In this case, we talk about signs of cholecystopancreatitis;
As a result of decreased absorption of amino acids into duodenum a state of hypoproteinemia develops, in which the amount of total protein and transaminases in the blood decreases.

Currently considered to be the most specific and valuable for early laboratory diagnostics acute inflammation of pancreatic tissue will determine the concentration:

trypsin;
carboxypeptidases;
alpha-chymotrypsin;
The concentration of phospholipase A plays a particularly important role.

It is this enzyme that is very important in diagnosing the prevalence of pancreatic necrosis, and is directly related to the prognosis. But, unfortunately, these enzymes can only be determined in large clinics with well-organized laboratories, since their correct determination is quite difficult. Also, when analyzing acid alkaline indicators blood, the development of metabolic acidosis can be detected.

Of course, there are other tests to determine pancreatitis, but the attending physician decides which test to take. As a rule, the patient is in the emergency surgery department at this time and is given pancreatic lipase or elastase at his own discretion. at will he can not. The fact is that each hospital operates according to certain protocols, and all tests are strictly regulated.

If a doctor is appointed to prescribe tests that go beyond the regulations and will lead to “extra” diagnostic costs, Insurance companies Such a department will be fined if the doctor does not accurately argue and indicate the need for this particular analysis in the medical history.

In outpatient practice, everything is much simpler. In case of chronic pancreatitis, a person resolves his issues with his attending physician - a gastroenterologist. And the symptoms, diagnosis and treatment for chronic damage to the pancreas are different than for the acute process. What tests can be performed in outpatient practice for chronic pancreatic lesions, and what important things will they show?

Other studies

As a rule, excessive in-depth study of blood tests, biochemical parameters, etc. cellular composition and into red blood is uninformative unless the functioning of the gland is assessed using imaging methods. In many diseases, a laboratory symptom complex of pancreatitis may occur, but it cannot be assessed separately.

Perhaps, only the level of pancreatic enzymes in the blood plasma and hyperglycemia most speak of pancreatitis, but even these signs must be clearly accompanied by either a picture of an acute abdomen, or signs of edema and enlargement of the pancreas during ultrasound, X-ray computed tomography, or MRI. Has not lost its meaning X-ray examination. If necessary, an FGDS or laparoscopy is performed.

As for chronic pancreatitis, the most common method of laboratory verification of this diagnosis is a digestive disorder. IN in this case We are talking about a deficiency of enzymes, and not at all about their excessive release into the blood. In this case, the patient will experience symptoms of intestinal dyspepsia, flatulence, abdominal discomfort, and belching.

Of the laboratory tests, the most informative will not be blood tests at all, but stool tests. If the pancreas secretes little lipase and other enzymes, then undigested food debris and drops of fat will be present in the stool; this undigested fat will make the stool slippery and cause the patient to experience frequent and chronic attacks of diarrhea with pancreatitis.