The salient investigations in chronic pancreatitis include: (1)
- 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
- 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
Note - Secretin-enhanced magnetic resonance cholangiopancreatography (s-MRCP) is suggested when the diagnosis of chronic pancreatitis is not confirmed following cross-sectional imaging with CRT/MRI or endoscopic ultrasound, and clinical suspicion remains high. It allows for better visualisation of the main and side branch pancreatic ducts. (2)
- 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
- Gardner TB, Adler DG, Forsmark CE, et al. ACG clinical guideline: chronic pancreatitis. Am J Gastroenterol. 2020 Mar;115(3):322-39.
- Sherman S et al. Administration of secretin (RG1068) increases the sensitivity of detection of duct abnormalities by magnetic resonance cholangiopancreatography in patients with pancreatitis. Gastroenterology. 2014;147:646-54.e2.
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