investigation

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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:

 

Last reviewed 02/2021

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