Pancreatic Insufficiency

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Laboratory tests

  • Fecal fat (fat in the stool) is often the first sign of insufficiency. The simplest test for fecal fat is to place a suspension of stool onto a glass slide, add a fat stain, and observe the number and size of fat globules that are present. A more accurate assessment of fecal fat requires a timed stool collection and a dietary sheet to help calculate the total fat intake during the collection period. A variation of the test is called the acid steatocrit, which provides a rapid but less exact measure of the amount of fat in the stool.
  • Trypsin (an enzyme that digests protein): stool trypsin tests are used to determine whether sufficient amounts of this pancreatic enzyme are reaching the intestines.
  • Trypsinogen (Immunoreactive trypsin): a serum test that, when low, also detects pancreatic sufficiency.
  • Elastase is a protein-cleaving enzyme produced and secreted by the pancreas. It is resistant to degradation by other enzymes and so is excreted and can be measured in the stool. The amount of this enzyme is reduced in pancreatic insufficiency.

Non-laboratory tests

  • Endoscopic retrograde cholangiopancreatography (ERCP): a test that uses a flexible scope inserted through the mouth and threaded through the esophagus to see and document damage to the pancreas and/or bile ducts.
  • Magnetic resonance choangiopancreatography (MRCP): a type of magnetic resonance imaging (MRI) used to examine the pancreas and bile ducts.
  • Secretin test (not widely available): a tube is positioned in the duodenum to collect pancreatic secretions stimulated by intravenous (IV) secretin. The amount of certain enzymes and bicarbonate in the pancreatic secretion is measured and compared to normal values.

For more on imaging studies, see the web site

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