investigation
Last reviewed 03/2022
The salient investigations in chronic pancreatitis include:
- blood tests:
- serum amylase - usually normal but may be mildly raised in an acute on chronic attack
- albumin and clotting studies - may be abnormal due to associated cirrhosis or malabsorption
- low calcium or serum vitamin B12 suggests malabsorption
- elevated alkaline phosphatase suggests biliary tract obstruction if gamma GT is raised, or rarely, osteomalacia
- glucose may be raised if exocrine insufficiency
- imaging:
- abdominal x-ray - 30% show pancreatic calcification in later stages
- ultrasound - reveals gallstones, duct dilatation, pancreatic morphology
- CT scan - indicated if ultrasound is abnormal; shows major abnormalities
in pancreatic anatomy
- computed tomography is the first-line imaging modality for people with a history and symptoms suggestive of chronic alcohol-related pancreatitis (1)
- ERCP - "gold standard"; reveals duct dilatation and distortion of main pancreatic duct and side branches; however, a normal ERCP does not absolutely exclude chronic pancreatitis
- functional tests - e.g. secretin, Lundh, pancreolauryl tests - useful in the diagnosis of patients who have recurrent symptoms and whose imaging and other tests are normal
- tests of pancreatic exocrine and endocrine function
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