Serum amylase remains the most commonly used biochemical marker for the diagnosis of acute pancreatitis, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism.
For the diagnosis of acute pancreatitis, serum amylase remains the most commonly used biochemical marker, but its sensitivity can be reduced by late presentation, hypertriglyceridaemia, and chronic alcoholism.
AP is diagnosed when two or more of the following three findings are satisfied [1,2]: (1) upper abdominal pain suggestive of pancreatitis, excluding pain from other conditions, such as gastric/duodenal ulcer perforation or aortic dissection, myocardial infarction, etc.; (2) an increased level of serum amylase or lipase ...
Amylase and lipase, secreted by the acinar cells of the pancreas, are the most common laboratory markers used to establish the diagnosis of acute pancreatitis5,10 (Table 25,11 ).
AP is diagnosed on the basis of two of three criteria—typically belt-like abdominal pain, an elevated serum lipase level three times above the normal threshold, and radiological imaging signs of pancreatitis [4,5,6]. The first two are present in the most of patients, whereas the latter occurs slightly less frequently.
Amylase (the pancreatic enzyme responsible for digesting carbohydrates) is the most common blood test for acute pancreatitis. It increases from 2 to 12 hours after the beginning of symptoms and peaks at 12 to 72 hours.
The factors most closely linked to a poor prognosis are pancreatic necrosis, infection and multiple organ/systemic failures, which are associated with a mortality of 50%[4-7]; although in recent years this mortality rate has tended to decrease[8].
PCT is the first biochemical variable for predicting severe pancreatic infections and overall prognosis throughout the course of acute pancreatitis with high sensitivity and specificity.
The diagnosis of AP involves two of the following three: abdominal pain characteristic of pancreatitis, lipase greater than two-thirds of the upper limit of normal and imaging findings of acute pancreatitis. In chronic pancreatitis, patients can have a normal lipase and amylase level.
Most people with acute pancreatitis improve within a week and experience no further problems, but severe cases can have serious complications and can even be fatal.
Acute pancreatitis is usually caused by gallstones or drinking too much alcohol, but sometimes no cause can be identified.
Medical management of mild acute pancreatitis is relatively straightforward. The patient is kept NPO (nil per os—that is, nothing by mouth), and intravenous (IV) fluid hydration is provided. Analgesics are administered for pain relief. Antibiotics are generally not indicated.
The normal range for adults younger than 60 is 10 to 140 U/L. Normal results for adults ages 60 and older is 24 to 151 U/L. Higher than normal levels of lipase mean that you have a problem with your pancreas. If your blood has 3 to 10 times the normal level of lipase, then it's likely that you have acute pancreatitis.
We recommend estimating lipase levels alone for the diagnosis of acute pancreatitis as it is more sensitive than amylase, lasts longer, and is elevated in conditions like hypertriglyceridemia where amylase may be normal [3,4]. However, amylase levels continue to be frequently ordered concurrently [5].
Death during the first several days of acute pancreatitis is usually caused by failure of the heart, lungs, or kidneys. Death after the first week is usually caused by pancreatic infection or by a pseudocyst that bleeds or ruptures.
Mortality due to acute pancreatitis is increased as the number of present prognostic signs increases. The mortality rate is less than 5% among those with less than three signs, whereas it can increase to up to 20% among those with three signs or more.
A biopsy is the only way to confirm a pancreatic cancer diagnosis. Magnetic resonance imaging (MRI) uses radio waves and magnets to produce detailed images of the pancreas and bile ducts.
A CBC test shows the level of white blood cells and red blood cells in the blood, among other components. A CBC test can indicate a possible infection related to pancreatitis. However, a full blood count alone is not enough to diagnose pancreatitis.
Local complications of acute pancreatitis include early (less than four weeks, peripancreatic fluid collection, and pancreatic/peripancreatic necrosis) and late (more than four weeks, pancreatic pseudocyst, and walled-off necrosis).
Prolonged bowel rest by nothing per os (NPO) to minimize pancreatic secretion was an important part of the therapy for any patient with acute pancreatitis. The concept of nutritional support in AP has gradually moved towards enteral feeding, due to large evidence proving safety and efficiency (31).
Acute pancreatitis is self-limiting, meaning it usually resolves on its own over time.
Key points about pancreatitis
The most common causes are alcohol abuse and lumps of solid material (gallstones) in the gallbladder. The goal for treatment is to rest the pancreas and let it heal. You will likely be in the hospital for a few days.