The pancreas plays a crucial role in the human body as it has exocrine functions that produce several important enzymes to aid in the digestive process, such as trypsin, chymotrypsin, amylase, and lipase. It also has endocrine functions where it produces and releases hormones like insulin and glucagon to control blood sugar levels. Several examinations are required to assess the pancreas's function as an initial screening for pancreatic disorders.

Here are some examinations that can be conducted:

1. Assessing the General Function of the Pancreas, examinations such as:
   A. Abdominal Ultrasound (USG):
      Diagnostic imaging using sound waves (without radiation) to examine the visual condition of organs within the abdominal cavity, such as the pancreas, bile ducts, and other digestive structures. Through abdominal USG, the anatomical structure of the pancreas and any abnormalities, such as the presence of gallstones or inflammation, can be assessed.

   B. Endoscopic Retrograde Cholangiopancreatography (ERCP):
      ERCP combines endoscopy and X-ray imaging by inserting a thin tube equipped with a camera and a light source through the patient's mouth to reach the end of the bile ducts and pancreas. This procedure allows for detailed imaging and evaluation of the bile ducts and pancreas.

   C. Carcinoembryonic Antigen (CEA) and Cancer Antigen 19-9 (Ca 19-9)*:
      These examinations screen for the presence of malignancy or tumor markers in the pancreas. In a clinical setting, these tests are often combined with other examinations to monitor cancer treatment, including treatment response, recurrence, indicators of tumor size or quantity, prognosis, and cancer stage estimation.

   D. Pancreatic CT-Scan:
      Through a CT-Scan, abnormalities in the pancreas, such as cancer or other abnormalities, can be detected, and evaluations can be made in case of pancreatic inflammation.

   E. MRI:
      This non-invasive examination provides images of the pancreas, aiding in confirming any changes in the shape or structure of the gallbladder.

2. Assessing the Endocrine Function of the Pancreas:
   Examination of the endocrine function of the pancreas is closely related to assessing the risk of Diabetes Mellitus (DM). Various examinations can be performed, including:
   a. Blood Glucose Examination:
      Tests such as Fasting Blood Sugar (FBS), 2-Hour Post Prandial Blood Sugar (2HPP), and Oral Glucose Tolerance Test (OGTT) can be conducted. One of the diagnostic criteria for DM is the presence of clinical symptoms and a fasting blood glucose level (FBS) > 200 mg/dL or a fasting plasma glucose (FPG) level ≥ 126 mg/dL or an Oral Glucose Tolerance Test (OGTT) level ≥ 200 mg/dL.

   b. HbA1c Examination:
      This test measures the average amount of red blood cells or hemoglobin bound to blood sugar over the past 3 months. The results are categorized as follows:
      • Normal HbA1c: <5.7%
      • Prediabetes HbA1c: 5.7-6.4%
      • Diabetes HbA1c: ≥6.5%

3. Assessing the Exocrine Function of the Pancreas:
   The exocrine function of the pancreas is related to its role in digestion through the production of several enzymes. Examinations that can be conducted include:
   a. Amylase:
      Amylase is produced by the pancreas to digest carbohydrates. The serum amylase level increases in cases of acute pancreatitis, typically accompanied by severe abdominal pain.

   b. Lipase:
      Lipase is an enzyme produced by the pancreas that digests fats. Lipase levels in the blood increase when there is damage to the pancreas. Elevated levels of lipase and amylase occur at the onset of pancreatitis.

REFERENCES

1. Cleveland Clinic. Diagnostics & Testing. ERCP (Endoscopic Retrograde Cholangiopancreatography); 2020.
2. Coban E, Samur M, Bozcuk H, Ozdogan M. The value of CEA and CA 19-9 in Detecting Cancer in a Group of High-Risk Subjects with Gastrointestinal Symptoms. The International Journal of Biological Markers; 2003.
3. Feldman M, et al. Gallstone disease. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. 10th ed. Philadelphia, Pa.: Saunders Elsevier; 2016.
4. Portincasa P, et al. Preventing a Mass Disease: The Case of Gallstone Disease: Role and Competence for Family Physicians; 2016.

Author: Dr. Rosy Rahma Sari (Medical Laboratory Consultant at PRAMITA Clinic, Jl. Letjen. Hertasning, Ruko Pena Mas No. 3-4 Makassar)