Exocrine Pancreatic Insufficiency Workup: Laboratory Studies, Pancreatic Function Tests, Abdominal Imaging

A complete laboratory evaluation is required not only to diagnose exocrine pancreatic insufficiency (EPI) but also to determine the extent of the malabsorption and assess manifestations of the underlying disease, if present. Blood tests A complete blood count (CBC) may reveal microcytic anemia due to iron deficiency or macrocytic anemia due to vitamin B-12 or folate malabsorption. Serum iron, vitamin B-12, and folate concentrations may help establish the diagnosis of EPI. Prothrombin time (PT) may be prolonged because of malabsorption of vitamin K, a fat-soluble vitamin. A study by Lindkvist et al found that serum nutritional markers (eg, magnesium, albumin, prealbumin) can be used to determine the probability of EPI in patients with chronic pancreatitis. [27] Malabsorption can involve electrolyte imbalances such as hypokalemia, hypocalcemia, hypomagnesemia, and metabolic acidosis. Protein malabsorption may cause hypoproteinemia and hypoalbuminemia. Fat malabsorption can lead to low se...