Investigation

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
  
  
  
  
  
  
  
  
  
  
  
  

Reference:

• 1) NICE (June 2010). Alcohol use disorders.