Hereditary pancreatitis laboratory findings: Difference between revisions

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==Laboratory Findings==
==Laboratory Findings==
* 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


*There are no diagnostic laboratory findings associated with [disease name].
==== Fecal tests: ====
OR
*An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
*[Test] is usually normal among patients with [disease name].
*Laboratory findings consistent with the diagnosis of [disease name] include:
**[Abnormal test 1]
**[Abnormal test 2]
**[Abnormal test 3]


*Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
===== (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.<ref name="UpTo">{{cite web |author=Freedman SD |url=http://www.uptodate.com/patients/content/topic.do?topicKey=~EzkfCtNwumVrg |title=Clinical manifestations and diagnosis of chronic pancreatitis in adults |format= |work=UpToDate  |accessdate=}}</ref><ref name="pmid15285176">{{cite journal |vauthors=Keim V, Teich N, Moessner J |title=Clinical value of a new fecal elastase test for detection of chronic pancreatitis |journal=Clin. Lab. |volume=49 |issue=5-6 |pages=209–15 |year=2003 |pmid=15285176 |doi= |url=}}</ref><ref name="pmid12093988">{{cite journal |vauthors=Walkowiak J, Herzig KH, Strzykala K, Przyslawski J, Krawczynski M |title=Fecal elastase-1 is superior to fecal chymotrypsin in the assessment of pancreatic involvement in cystic fibrosis |journal=Pediatrics |volume=110 |issue=1 Pt 1 |pages=e7 |year=2002 |pmid=12093988 |doi= |url=}}</ref><ref name="pmid15343184">{{cite journal |vauthors=Borowitz D, Baker SS, Duffy L, Baker RD, Fitzpatrick L, Gyamfi J, Jarembek K |title=Use of fecal elastase-1 to classify pancreatic status in patients with cystic fibrosis |journal=J. Pediatr. |volume=145 |issue=3 |pages=322–6 |year=2004 |pmid=15343184 |doi=10.1016/j.jpeds.2004.04.049 |url=}}</ref>
=== Pancreatic function tests: ===
 
===== (a) Direct/ Invasive tests: =====
* Direct tests are used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiology findings.
* Direct tests involve pancreatic stimulation via meal or hormonal secretagogues and assessment of pancreatic secretions in the duodenal fluid.
* Direct tests along with radiographic findings (pancreatic calcifications) are stll considered to be the gold standard for the diagnosis of chronic pancreatitis.<ref name="pmid11276375">{{cite journal |vauthors=Boeck WG, Adler G, Gress TM |title=Pancreatic function tests: when to choose, what to use |journal=Curr Gastroenterol Rep |volume=3 |issue=2 |pages=95–100 |year=2001 |pmid=11276375 |doi= |url=}}</ref><ref name="pmid12641496">{{cite journal |vauthors=Chowdhury RS, Forsmark CE |title=Review article: Pancreatic function testing |journal=Aliment. Pharmacol. Ther. |volume=17 |issue=6 |pages=733–50 |year=2003 |pmid=12641496 |doi= |url=}}</ref><ref name="pmid15508057">{{cite journal |vauthors=Siegmund E, Löhr JM, Schuff-Werner P |title=[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis] |language=German |journal=Z Gastroenterol |volume=42 |issue=10 |pages=1117–28 |year=2004 |pmid=15508057 |doi=10.1055/s-2004-813604 |url=}}</ref><ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref>
* The limitation of direct tests is that they are costly and cumbersome.<ref name="pmid11276375">{{cite journal |vauthors=Boeck WG, Adler G, Gress TM |title=Pancreatic function tests: when to choose, what to use |journal=Curr Gastroenterol Rep |volume=3 |issue=2 |pages=95–100 |year=2001 |pmid=11276375 |doi= |url=}}</ref><ref name="pmid12641496">{{cite journal |vauthors=Chowdhury RS, Forsmark CE |title=Review article: Pancreatic function testing |journal=Aliment. Pharmacol. Ther. |volume=17 |issue=6 |pages=733–50 |year=2003 |pmid=12641496 |doi= |url=}}</ref><ref name="pmid15508057">{{cite journal |vauthors=Siegmund E, Löhr JM, Schuff-Werner P |title=[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis] |language=German |journal=Z Gastroenterol |volume=42 |issue=10 |pages=1117–28 |year=2004 |pmid=15508057 |doi=10.1055/s-2004-813604 |url=}}</ref><ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref>
* Direct tests include:
** [[Secretin]] stimulation test
** Pancreozymin-secretin test
*[[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%<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%<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/ Non-invasive tests: =====
* Indirect tests are used to assess the complications of chronic pancreatitis.
* Indirect tests include:
** Faecal chymotrypsin, PABA-, pancreolauryl-
** Faecal elastase test
* Indirect tests are not sensitive to assess pancreatic insufficiency in the early course of disease.<ref name="pmid16633964">{{cite journal |vauthors=Ammann RW |title=Diagnosis and management of chronic pancreatitis: current knowledge |journal=Swiss Med Wkly |volume=136 |issue=11-12 |pages=166–74 |year=2006 |pmid=16633964 |doi=2006/11/smw-11182 |url=}}</ref><ref name="pmid11179244">{{cite journal |vauthors=Etemad B, Whitcomb DC |title=Chronic pancreatitis: diagnosis, classification, and new genetic developments |journal=Gastroenterology |volume=120 |issue=3 |pages=682–707 |year=2001 |pmid=11179244 |doi= |url=}}</ref>


==References==
==References==

Revision as of 01:11, 8 January 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Iqra Qamar M.D.[2]

Overview

An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].

OR

Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].

OR

[Test] is usually normal among patients with [disease name].

OR

Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].

OR

There are no diagnostic laboratory findings associated with [disease name].

Laboratory Findings

  • 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

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.[1][2][3][4]

Pancreatic function tests:

(a) Direct/ Invasive tests:
  • Direct tests are used to assess pancreatic insufficiency in the early course of disease when patient has clinical symptoms but no radiology findings.
  • Direct tests involve pancreatic stimulation via meal or hormonal secretagogues and assessment of pancreatic secretions in the duodenal fluid.
  • Direct tests along with radiographic findings (pancreatic calcifications) are stll considered to be the gold standard for the diagnosis of chronic pancreatitis.[5][6][7][8]
  • The limitation of direct tests is that they are costly and cumbersome.[5][6][7][8]
  • Direct tests include:
    • Secretin stimulation test
    • Pancreozymin-secretin test
  • 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%[9]
      • Specificity- 86%[9]
(b) Indirect/ Non-invasive tests:
  • Indirect tests are used to assess the complications of chronic pancreatitis.
  • Indirect tests include:
    • Faecal chymotrypsin, PABA-, pancreolauryl-
    • Faecal elastase test
  • Indirect tests are not sensitive to assess pancreatic insufficiency in the early course of disease.[8][10]

References

  1. ↑ Freedman SD. "Clinical manifestations and diagnosis of chronic pancreatitis in adults". UpToDate.
  2. ↑ 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.
  3. ↑ 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.
  4. ↑ 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.
  5. ↑ 5.0 5.1 Boeck WG, Adler G, Gress TM (2001). "Pancreatic function tests: when to choose, what to use". Curr Gastroenterol Rep. 3 (2): 95–100. PMID 11276375.
  6. ↑ 6.0 6.1 Chowdhury RS, Forsmark CE (2003). "Review article: Pancreatic function testing". Aliment. Pharmacol. Ther. 17 (6): 733–50. PMID 12641496.
  7. ↑ 7.0 7.1 Siegmund E, Löhr JM, Schuff-Werner P (2004). "[The diagnostic validity of non-invasive pancreatic function tests--a meta-analysis]". Z Gastroenterol (in German). 42 (10): 1117–28. doi:10.1055/s-2004-813604. PMID 15508057.
  8. ↑ 8.0 8.1 8.2 Ammann RW (2006). "Diagnosis and management of chronic pancreatitis: current knowledge". Swiss Med Wkly. 136 (11–12): 166–74. doi:2006/11/smw-11182 Check |doi= value (help). PMID 16633964.
  9. ↑ 9.0 9.1 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.
  10. ↑ Etemad B, Whitcomb DC (2001). "Chronic pancreatitis: diagnosis, classification, and new genetic developments". Gastroenterology. 120 (3): 682–707. PMID 11179244.

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