Obligatory medical device diagnostics.
- Abdominal ultrasonography (ultrasound examination of the abdominal organs (in this case, pancreatic ultrasonography/ultrasound examination of the pancreas) – as a basic diagnostic test and method of choice in mild courses of disease
- [acute pancreatitis: edema (water retention), hypoechogenic (“echo-poor”) pancreatic enlargement, free fluid, possibly indication of biliary (gallbladder-related) cause
- Chronic pancreatitis: calcifications; uncertain signs: inhomogeneous organ with normally wide pancreatic duct]
Optional medical device diagnostics – depending on the results of the history, physical examination, laboratory diagnostics and obligatory medical device diagnostics – for differential diagnostic clarification.
- Electrocardiogram (ECG; 12-lead ECG; recording of myocardial electrical activity) – to delineate concomitant complicating factors of pancreatitis (e.g., tachycardic atrial fibrillation due to electrolyte shifts (e.g., hypokalemia/potassium deficiency, hypomagnesemia/magnesium deficiency) or volume deficiency)
- Endosonography* (EUS; ultrasound examination by endoscopic route) provides the highest spatial resolution in imaging of the pancreas; performed with endosonography-assisted fine-needle biopsy – when there is uncertain evidence of chronic pancreatitis [method of choice]; for clarification in cases of suspected obstruction (narrowing) of the bile ducts.
- Computed tomography (CT) of the abdomen (abdominal CT) – for suspected complicated courses as the method of choice in acute pancreatitis (gold standard for necrosis detection/necrotizing pancreatitis) and for detection of calcifications and pseudocysts in chronic pancreatitisNote: A severity prognosis cannot be recommended by CT.
- Magnetic resonance cholangiopancreatography (MRCP)* – in cases of suspected chronic pancreatitis and unclear pancreatic changes in sonography (ultrasound examination) to obtain more detailed information about the pancreatic duct system.
- Magnetic resonance imaging of the abdomen (abdominal MRI).
- When complicated courses are suspected
- In children: in case of complications/malformation; if necessary, contrast-enhanced ultrasound (CEUS).
- X-ray abdomen overview
- Endoscopic retrograde cholangiopancreaticography (ERCP; diagnostic method combining the procedures of a speculum and radiology; for visualization of the bile ducts, gallbladder and pancreatic duct) with papillotomy (splitting of the papilla duodeni major along with the sphincter apparatus (sphincter oddi); this is located at the common opening of the ductus choledochus (common bile duct) and ductus pancreaticus (pancreatic duct) into the duodenum (duodenum)) – in uncomplicated biliary pancreatitis (pancreatitis in the context of a bile duct-related obstruction) within 72 hrs; immediately in the case of cholangitis (inflammation of the bile duct) and sepsis (blood poisoning) [in the case of chronic pancreatitis, ERCP should not be performed because of the higher morbidity (illness). Higher morbidity (incidence of disease) (5-10%, 3.47% post-ERCP pancreatitis) and mortality (death rate) of 3.3%].
Further notes
- * In individual cases, if EUS and MRCP are inadequate, endoscopic retrograde pancreatography (ERP; diagnostic method that combines the procedures of a mirror imaging and radiology; to visualize the pancreatic duct) can be performed. Likewise, ERP can also be used in autoimmune pancreatitis.
- In approximately 30% of patients with acute pancreatitis, signs resembling posterior wall infarction can be detected on ECG.
