What tests should be run at the Primary Care Physician (PCP) office after a patient has been admitted for pancreatitis?

Post-Pancreatitis Follow-Up Tests at PCP Office

After hospital admission for acute pancreatitis, patients should undergo follow-up testing at the PCP office including liver function tests, fasting lipid panel, fasting calcium levels, and repeat biliary ultrasound to determine etiology and prevent recurrence. 1

Essential Follow-Up Tests

Etiological Assessment

1. Liver Function Tests

   • Essential for identifying potential gallstone etiology 2, 1
   • Elevated aminotransferases or bilirubin suggest gallstone pancreatitis 2

2. Repeat Biliary Ultrasound

   • Even after negative initial ultrasound, repeat examination is recommended 2
   • Most sensitive test for diagnosing gallstones that may have been missed initially 2

3. Fasting Blood Tests

   • Lipid panel: To identify hypertriglyceridemia as potential cause 2, 1
   • Calcium levels: To rule out hypercalcemia as etiology 2, 1

4. Blood Glucose Monitoring

   • Essential to detect new-onset diabetes mellitus, a common complication 1, 3
   • Elevated glucose is a risk factor for severe disease 1

Disease Monitoring

1. C-reactive Protein (CRP)

   • If symptoms persist, CRP is the best available laboratory marker of severity 1, 4
   • CRP ≥150 mg/L indicates severe disease with ~80% accuracy 1

2. Pancreatic Enzyme Levels

   • Note: Daily measurements of amylase/lipase have no value in assessing clinical progress 4
   • Only check if symptoms suggest recurrence 4

Specialized Testing Based on Clinical Presentation

For Persistent or Recurrent Symptoms

• Pancreatic function tests: If symptoms suggest exocrine insufficiency (diarrhea, weight loss) 3
• HbA1c: To assess glycemic control if diabetes is suspected 1
• Helicobacter pylori testing: If peptic ulcer disease is suspected with persistent abdominal pain 1

For Idiopathic Cases

If no clear etiology is identified after initial testing:

• Consider referral for Magnetic Resonance Cholangiopancreatography (MRCP) 2, 1
• Consider referral for Endoscopic Ultrasound (EUS) if microlithiasis is suspected 2

Important Considerations and Pitfalls

Common Pitfalls

• Overlooking drug-induced pancreatitis: Review medication list thoroughly, especially for high-risk medications like azathioprine, valproic acid, furosemide, and tetracycline 5
• Missing microlithiasis: Small gallstones may be missed on initial imaging 2
• Failing to assess for pancreatic insufficiency: 76% of patients have ongoing symptoms suggestive of pancreatic dysfunction after severe acute pancreatitis 3

Quality of Life Assessment

• Patients who have had severe acute pancreatitis often have significantly reduced quality of life 3
• Assessment of ongoing symptoms including abdominal pain, diarrhea, unintentional weight loss should be performed 3

Follow-Up Schedule

• First follow-up within 2-4 weeks after discharge 1
• For gallstone pancreatitis, ensure surgical referral for cholecystectomy within 2-4 weeks of discharge 1
• Subsequent follow-up frequency based on severity of initial attack and persistence of symptoms 1

Remember that the etiology of acute pancreatitis should be established in at least 75% of patients, with less than 20% classified as idiopathic 1. A thorough follow-up evaluation is essential to identify the cause, prevent recurrence, and manage complications.