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Since chronic pancreatitis (CP) results in both functional and structural damage to the pancreas, diagnostic tests are designed to evaluate both of these factors. Pancreatic tissue biopsy is ideally the gold standard for diagnosis with a correlation of almost 100%, but there is a high risk of complications since the procedures used to sample the tissue are invasive. Doctors continue to investigate diagnostic methods that are accurate and reliable but carry minimal complications.

A typical diagnostic evaluation for chronic pancreatitis includes:

• Physical examination
• Exocrine function evaluation
• Endocrine function evaluation
• Evaluation of structural damage to the pancreas by imaging studies
• Genetic testing
• Immunological testing

Physical Examination

A physical examination usually does not yield sufficient information for a definitive diagnosis of chronic pancreatitis but may raise the index of suspicion under the following circumstances:

• If the patient is in pain, they may assume a typical posture to relieve the pain, namely lying on their side in the fetal position (knees drawn up to chest) or sitting up and leaning forward.
• Sometimes the doctor may palpate a tender fullness in the upper abdominal area which may indicate an inflammation or a pseudocyst.
• The patient may have signs of malnutrition, including temporal wasting (indentations at the temples on the sides of the head), a decrease in subcutaneous fat (normal fat tissue under the skin), or a generalized sunken look.

Exocrine Function Evaluation

This aspect of the evaluation measures the digestive enzymes for exocrine insufficiency which would indicate that the pancreas has ceased producing and secreting enough digestive enzymes.

Laboratory Evaluation

Blood tests may be helpful for initial screening. These tests include:

• Complete blood count (CBC) - this will typically be elevated if there is infection
• Serum pancreatic enzyme assays (amylase, lipase). These values are elevated during an attack of acute pancreatitis and are often within normal limits for chronic pancreatitis.
• Serum trypsinogen levels may be low in advanced chronic pancreatitis. Measurement of serum trypsinogen is not sensitive enough to identify mild-moderate chronic pancreatitis.
• Serum calcium - some cases of CP are caused by hyperparathyroidism which causes elevated levels of calcium in the blood
• Fasting serum glucose which may reveal diabetes
• Immunoglobulin (Ig) panel - abnormalities of certain Ig values may be indicative of autoimmune pancreatitis

Pancreatic Function Tests

The following tests are used to determine if the pancreas is functioning properly. There are two types of tests:

• Direct Tests - These are invasive tests and are performed only rarely
• Indirect Tests - These types of tests are non-invasive

Direct Pancreatic Function Tests

• Secretin-Stimulation Test - This test measures the ability of the pancreas to respond to secretin which is a hormone involved in digestion. Secretin stimulates the pancreas to produce and secrete a fluid which is high in bicarbonate and which neutralizes the acidity in the stomach to aid in digestion. If the pancreatic ducts are blocked or if the cells needed to produce this fluid are compromised in any way or if there is any resistance to pancreatic juice outflow, the expected values will be affected. This test is invasive. A tube is inserted through the nose and is advanced into the duodenum and secretin is administered through the tube. Samples of duodenal fluid are aspirated at various intervals to evaluate pancreatic function. It is often performed in combination with endoscopic retrograde cholanigiopancreatography (ERCP).