Chronic pancreatitis laboratory findings
|
Chronic pancreatitis Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
American Pancreatic Association Practice Guidelines |
|
Chronic pancreatitis laboratory findings On the Web |
|
American Roentgen Ray Society Images of Chronic pancreatitis laboratory findings |
|
Risk calculators and risk factors for Chronic pancreatitis laboratory findings |
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.
- 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):
- 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]
References
- ↑ 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.