Laboratory Evaluation of Jaundice in Chronic Pancreatitis

Differential Diagnosis and Laboratory Findings

The American College of Radiology suggests that the differential diagnosis of obstructive jaundice in chronic pancreatitis includes choledocholithiasis, pancreatic adenocarcinoma, and Mirrizi's syndrome 1
Initial laboratory testing should include total and fractionated bilirubin, complete blood count, liver enzymes (AST, ALT, ALP, GGT), and synthetic function tests, as recommended by the American College of Radiology 2
The American College of Radiology notes that AST/ALT is more indicative of hepatocellular injury rather than biliary obstruction, while GGT is less specific than ALP for biliary obstruction in this context 2

The American College of Radiology recommends that after identifying elevated alkaline phosphatase, abdominal ultrasound should be performed as the first-line imaging study 3, 2
Further imaging with MRCP, CT, or ERCP may be necessary based on ultrasound findings, according to the American College of Radiology 4, 1