Exams and Tests

If your doctor thinks you have pancreatitis, he or she will ask questions about your medical history and do a physical exam along with lab and imaging tests.

Two blood tests that measure enzymes are used to diagnose an attack of pancreatitis. These tests are:

• Serum amylase. An increase of amylase in the blood usually indicates pancreatitis.
• Serum lipase. Sudden (acute) pancreatitis almost always raises the level of lipase in the blood.

Other blood tests may be done, such as:

• A complete blood count (CBC). The number of white blood cells rises during an attack of pancreatitis, sometimes dramatically.
• Liver function tests. Increases in liver enzymes, particularly of alanine aminotransferase and alkaline phosphatase, can be a sign of sudden pancreatitis caused by gallstones.
• Bilirubin. The level of bilirubin in the blood may increase if the common bile duct is blocked.

Imaging tests that may be done include:

• CT scan with contrast dye. A CT scan can help rule out other causes of abdominal pain, determine whether tissue is dying (pancreatic necrosis), and find complications such as fluid around the pancreas, bleeding, blocked veins, and obstructed bowels.
• Abdominal ultrasound. This test can locate gallstones and fluid caused by inflammation in the abdomen (ascites). It also can show an enlarged common bile duct, an abscess, or a pseudocyst.
• Endoscopic retrograde cholangiopancreatogram (ERCP). This procedure allows the doctor to see the structure of the common bile duct, other bile ducts, and the pancreatic duct. ERCP is the only diagnostic test that also can be used to treat narrow areas (strictures) of the bile ducts and remove gallstones from the common bile duct.
• Endoscopic ultrasound. In this form of ultrasound, a probe attached to a lighted scope is placed down the throat and into the stomach. Sound waves show images of organs in the abdomen. Endoscopic ultrasound may reveal gallstones in the common bile duct.
• MRI. Occasionally an MRI is used to look for signs of pancreatitis. It provides information similar to that of a CT scan.
• Magnetic resonance cholangiopancreatogram (MRCP). This form of MRI can detect gallstones in the common bile duct. This test is not available everywhere.

If your doctor is not sure whether your pancreatic tissue is infected, he or she may use a needle to take some fluid from the inflamed area. The fluid is then tested for organisms that can cause infection.

In severe, chronic pancreatitis, a stool analysis may be done to look for fat in stools, which is a sign that you may not be getting enough nutrition. This happens when the pancreas no longer produces the enzymes you need to digest fat.