Chronic pancreatitis laboratory findings: Difference between revisions
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Revision as of 14:10, 25 February 2013
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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 may well not be elevated in cases of advanced chronic pancreatitis, but are often used as markers for detecting pancreatic inflammation in acute pancreatitis.
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%).
Other common tests used to determine chronic pancreatitis are faecal elastase measurement in stool, serum trypsinogen.
There are other non-specific laboratory studies useful in diagnosis of chronic pancreatitis. Serum bilirubin and alkaline phosphatase can be elevated, indicating stricturing of the common bile duct due to edema, fibrosis or cancer. When the chronic pancreatitis is due to an autoimmune process, elevations in ESR, IgG4, rheumatoid factor, ANA and antismooth muscle antibody may be seen.
The common symptom of chronic pancreatits, steatorrhea, can be diagnosed by two different studies: Sudan staining of feces or fecal fat excretion over 24hr on a 100g fat diet.
To check for pancreatic exocrine dysfunction, the most sensitive and specific test is the measurement of fecal elastase, which can be done with a single stool sample, and a value of less than 200 ug/g indicates pancreatic insufficiency.[1]abdominal pain.
References
- ↑ Freedman SD. "Clinical manifestations and diagnosis of chronic pancreatitis in adults". UpToDate.