Editing Pancreatic nutritional disease (section)

== Diagnosis ==

* Imaging of pancreas for suggestive features
* Direct assessment of pancreatic function - direct measurement of secretions via duodenal sampling - fairly limited role for these in practice due to cost and difficulty
** Secretin-CCK stimulation test
** Lundh test
* Indirect tests
** 3-day faecal fat test - gold standard for diagnosing and quantifying steatorrhoea
*** Steatorrhoea is present if more than 7% of ingested fat is excreted (in patients over 6 months of age)
** Steatocrit - proportion of fat in a single stool
** Microscopic examination of stools for fat droplets
** Faecal chymotrypsin and elastase-1
*** Elastase-1 is recommended by UTD as the most commonly-performed test - sensitivity for mild, moderate and severe insufficiency of 63, 100 and 100 percent respectively; and specificity 93%
*** Faecal elastase-1 <200mcg/g is abnormal
*** Dilute diarrhoea from other causes can artificially lower the elastase-1 level
** Breath tests - limited use of these in Australia
** Serum trypsinogen - fairly good reflection of pancreatic function and reflects pancreatic acinar cell mass - cut-off of <20ng/mL is reasonably sensitive. Not sensitive for mild disease, or if levels are 21-30. Non-specific. Also cheap according to UTD.