CT is reported to be 60% to 95% sensitive in diagnosing advanced disease as it can readily detect parenchymal changes associated with advanced chronic pancreatitis[46].
ABSTRACT : In a prospective study of 91 patients with acute pancreatitis, computed tomographic (CT) findings were correlated with the clinical type of acute pancreatitis. In acute edematous pancreatitis (63 patients; 16 with repeat CT), CT was normal (28%) or showed inflammation limited to the pancreas (61%).
Results: There were 66/107 (62%) and 49/107 (46%) cases with missed and misinterpreted imaging findings, respectively.
Lipase is the preferred laboratory test for diagnosing acute pancreatitis, as it is the most sensitive and specific marker for pancreatic cell damage. Additional laboratory testing, such as complete blood count (CBC) and lactate dehydrogenase (LDH) tests, are useful to obtain prognostic information.
While the measurement of serum pancreatic enzymes such as amylase is the “gold standard” for the diagnosis of acute pancreatitis, the measured value for the serum pancreatic enzymes should be interpreted by considering the duration of patient's symptoms.
Hereditary pancreatitis may be present in someone under 30 years old but may go undiagnosed for several years. Brief periods of abdominal pain and diarrhea may come and go and eventually lead to chronic pancreatitis.
But if a medical professional did not follow the proper standards and protocols, mistakes can occur and the condition could be missed. Experienced medical malpractice attorneys can help you determine if your undiagnosed or misdiagnosed pancreatitis is compensable.
Severe acute pancreatitis
However, in minor necrosis (<30% of the gland), CT has a false-negative rate of 21% [12].
Overall, CT remains the best screening tool for detection of chronic pancreatitis and exclusion of other intra-abdominal pathology that may be indistinguishable from chronic pancreatitis based on clinical symptoms.
Degree of confidence
In a prospective study of 202 patients, Clavien et al reported a 92% sensitivity and 100% specificity in diagnosing acute pancreatitis via CECT. Balthazar et al reported an overall accuracy of 80-90% in the detection of pancreatic necrosis.
Unfortunately, many medical professionals may misdiagnose pancreatitis, because the symptoms share similarities with other diseases of the digestive system. Commonly, pancreatitis is mistaken for one of the following conditions: Ulcers. Gastroenteritis.
Tests and procedures used to diagnose pancreatitis include: Blood tests to look for elevated levels of pancreatic enzymes, along with white blood cells, kidney function and liver enzymes. Abdominal ultrasound to look for gallstones and pancreas inflammation.
The main symptom of acute pancreatitis is a severe, dull pain around the top of your stomach that develops suddenly. This aching pain often gets steadily worse and can travel along your back or below your left shoulder blade. Eating or drinking may also make you feel worse very quickly, especially fatty foods.
The study found that evidence of pancreatic cancer was initially missed in over a third of patients with post imaging pancreatic cancers, which is a huge window of lost opportunity."
In severe cases, pancreatitis can be life-threatening. If you have severe abdominal (tummy) pain that lasts for more than 20 minutes, call your doctor or visit the emergency department of your local hospital. Pancreatitis can be either acute (sudden onset) or chronic (ongoing and longer-term).
Chronic pancreatitis can mimic peptic ulcer disease, gastritis, and other gastrointestinal conditions, making it difficult to diagnose.
“Silent,” or painless, chronic pancreatitis (CP) exists when patients with diagnostic features of CP describe no abdominal pain. It is a poorly understood phenomenon but it is important as it may go unnoticed until serious complications arise, including pancreatic insufficiency, diabetes, and even cancer.
Based on trypsinogen-2, which is the most accurate biomarker available now, Actim Pancreatitis is the only rapid test that can identify acute pancreatitis at any phase of the inflammation.
Diagnosis is made when 2 out of 3 criteria are met: Symptoms consistent with pancreatitis (e.g. epigastric pain) Elevation of serum amylase or lipase (to 3 times normal level) Radiological features consistent with pancreatitis (e.g. CT or MRI)
C-reactive protein (CRP) is still considered to be the gold standard, with a cut-off value of 150 mg/ml 48 h after disease onset.
Most people with acute pancreatitis start to feel better within about a week and have no further problems. But some people with severe acute pancreatitis can go on to develop serious complications.
CONCLUSION: Acute pancreatitis is easy to recur even during treatment. The factors such as changes of pancreas structure and uncontrolled systemic inflammatory reaction are responsible for the recurrence of acute pancreatitis. Early refeeding increases the recurrence of acute pancreatitis.