Chronic pancreatitis laboratory findings: Difference between revisions
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* Used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiologic findings | * Used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiologic findings | ||
*[[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. | *[[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 - 82% | **Sensitivity - 82%<ref name="pmid23711627">{{cite journal |vauthors=Ketwaroo G, Brown A, Young B, Kheraj R, Sawhney M, Mortele KJ, Najarian R, Tewani S, Dasilva D, Freedman S, Sheth S |title=Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis |journal=Am. J. Gastroenterol. |volume=108 |issue=8 |pages=1360–6 |year=2013 |pmid=23711627 |pmc=5388854 |doi=10.1038/ajg.2013.148 |url=}}</ref> | ||
**Specificity- 86% | **Specificity- 86%<ref name="pmid23711627">{{cite journal |vauthors=Ketwaroo G, Brown A, Young B, Kheraj R, Sawhney M, Mortele KJ, Najarian R, Tewani S, Dasilva D, Freedman S, Sheth S |title=Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis |journal=Am. J. Gastroenterol. |volume=108 |issue=8 |pages=1360–6 |year=2013 |pmid=23711627 |pmc=5388854 |doi=10.1038/ajg.2013.148 |url=}}</ref> | ||
===== (b) Indirect tests: ===== | ===== (b) Indirect tests: ===== | ||
Revision as of 14:54, 6 November 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.
- Serum calcium and triglyceride levels may be elevated in hypertriglyceridemia induced pancreatitis.
- 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:[1][2][3]
- ESR
- IgG4
- Rheumatoid factor
- ANA
- Antismooth muscle antibody
Fecal 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):
- The most sensitive and specific test for pancreatic exocrine dysfunction.
- It can be done with a single random stool sample.
- The results are independent of pancreatic enzyme replacement therapy.
- A value of less than 200 ug/g indicates pancreatic insufficiency.[4][5][6][7]
Pancreatic function tests:
(a) Direct tests:
- Used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiologic findings
- 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.
(b) Indirect tests:
- Used to assess the complications of chronic pancreatitis
- Not sensitive to assess pancreatic insufficiency in the early course of disease
References
- ↑ Ghazale A, Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Clain JE, Pearson RK, Pelaez-Luna M, Petersen BT, Vege SS, Farnell MB (2007). "Value of serum IgG4 in the diagnosis of autoimmune pancreatitis and in distinguishing it from pancreatic cancer". Am. J. Gastroenterol. 102 (8): 1646–53. doi:10.1111/j.1572-0241.2007.01264.x. PMID 17555461.
- ↑ Hamano H, Kawa S, Horiuchi A, Unno H, Furuya N, Akamatsu T, Fukushima M, Nikaido T, Nakayama K, Usuda N, Kiyosawa K (2001). "High serum IgG4 concentrations in patients with sclerosing pancreatitis". N. Engl. J. Med. 344 (10): 732–8. doi:10.1056/NEJM200103083441005. PMID 11236777.
- ↑ Raina A, Krasinskas AM, Greer JB, Lamb J, Fink E, Moser AJ, Zeh HJ, Slivka A, Whitcomb DC (2008). "Serum immunoglobulin G fraction 4 levels in pancreatic cancer: elevations not associated with autoimmune pancreatitis". Arch. Pathol. Lab. Med. 132 (1): 48–53. doi:10.1043/1543-2165(2008)132[48:SIGFLI]2.0.CO;2. PMID 18181673.
- ↑ Freedman SD. "Clinical manifestations and diagnosis of chronic pancreatitis in adults". UpToDate.
- ↑ Keim V, Teich N, Moessner J (2003). "Clinical value of a new fecal elastase test for detection of chronic pancreatitis". Clin. Lab. 49 (5–6): 209–15. PMID 15285176.
- ↑ Walkowiak J, Herzig KH, Strzykala K, Przyslawski J, Krawczynski M (2002). "Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis". Pediatrics. 110 (1 Pt 1): e7. PMID 12093988.
- ↑ Borowitz D, Baker SS, Duffy L, Baker RD, Fitzpatrick L, Gyamfi J, Jarembek K (2004). "Use of fecal elastase-1 to classify pancreatic status in patients with cystic fibrosis". J. Pediatr. 145 (3): 322–6. doi:10.1016/j.jpeds.2004.04.049. PMID 15343184.
- ↑ 8.0 8.1 Ketwaroo G, Brown A, Young B, Kheraj R, Sawhney M, Mortele KJ, Najarian R, Tewani S, Dasilva D, Freedman S, Sheth S (2013). "Defining the accuracy of secretin pancreatic function testing in patients with suspected early chronic pancreatitis". Am. J. Gastroenterol. 108 (8): 1360–6. doi:10.1038/ajg.2013.148. PMC 5388854. PMID 23711627.