Chronic pancreatitis laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Laboratory Findings

• The diagnosis of chronic pancreatitis is typically based on tests on pancreatic structure and function, as direct biopsy of the pancreas is considered excessively risky.

• Serum amylase and lipase are usually normal but may be slightly elevated (neither diagnostic nor prognostic).
• Serum bilirubin and alkaline phosphatase levels may be elevated in case of intra-pancreatic biliary duct obstruction.
• The following lab tests are usually normal:
  • CBC
  • LFTs
  • Electrolytes

• A secretin stimulation test is considered the gold standard functional test for diagnosis of chronic pancreatitis. The observation that bi-carbonate production is impaired early in chronic pancreatitis has led to the rationale of use of this test in early stages of disease (sensitivity of 95%).
• Autoimmune pancreatitis can be diagnosed with elevated levels of:
  • ESR
  • IgG4
  • Rheumatoid factor
  • ANA
  • Antismooth muscle antibody

Pancreatic function tests:

(a) Sudan staining of feces:

• A non-specific, qualitative test that is no longer used for the diagnosis of steatorrhea

(b) 72-hour quantitative fecal fat (Gold standard):

• A quantitaive test that determines fetal fat excretion for over 24hrs.
• Fecal fat excretion of >7g/day is diagnostic of malabsorption.
• Patients with steatorrhea usually have an excretion of >10g of fat per day.

(c) Faecal elastase measurement (Test of choice):

• Elevations in ESR, IgG4, rheumatoid factor, ANA and antismooth muscle antibody may be seen when the cause is autoimmune.

• steatorrhea can be diagnosed by two different studies:
  • Sudan staining of feces or
  • Fecal fat excretion over 24hr on a 100g fat diet.

• Fecal elastase measurement- the most sensitive and specific test for pancreatic exocrine dysfunction, which can be done with a single stool sample, and a value of less than 200 ug/g indicates pancreatic insufficiency.

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