Materiały źródłowe

• #1 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  The pancreas is a glandular organ that is responsible for the proper functioning of the digestive and endocrine systems, and therefore, it affects the condition of the entire body. Consequently, it is important to effectively diagnose and treat diseases of this organ. […] Effective diagnostic methods and the correct assessment of the severity of acute pancreatitis determine the selection of an appropriate treatment strategy and the prediction of the clinical course of the disease, thus preventing life-threatening complications and organ dysfunction or failure. […] Two phases of AP have been identified: early and late, while the severity has been divided into mild, moderate, and severe. […] Basically, at least two of the following symptoms must be present for a diagnosis of acute pancreatitis: abdominal pain, described as a persistent and severe epigastric pain often radiating to the back with acute onset; activity of the serum lipase or amylase at least three times greater than the upper limit of normal; and the characteristic symptoms of acute pancreatitis detected by ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI).

• #2 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  The pancreas is a glandular organ that is responsible for the proper functioning of the digestive and endocrine systems, and therefore, it affects the condition of the entire body. Consequently, it is important to effectively diagnose and treat diseases of this organ. According to clinicians, pancreatitis—a common disease affecting the pancreas—is one of the most complicated and demanding diseases of the abdomen. The classification of pancreatitis is based on clinical, morphologic, and histologic criteria. Medical doctors distinguish, inter alia, acute pancreatitis (AP), the most common causes of which are gallstone migration and alcohol abuse. Effective diagnostic methods and the correct assessment of the severity of acute pancreatitis determine the selection of an appropriate treatment strategy and the prediction of the clinical course of the disease, thus preventing life-threatening complications and organ dysfunction or failure. This review collects and organizes recommendations and guidelines for the management of patients suffering from acute pancreatitis. […]

• #3 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  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. […] The revised Atlanta classification system from 2012, defining the clinical diagnosis, CT manifestations, and the disease course of acute pancreatitis, distinguishes two morphologic subtypes of AP: interstitial oedematous pancreatitis and necrotizing pancreatitis. […] The aforementioned classification, evaluating additional local or systemic complications as well as the presence and duration of organ failure, divides AP into three subtypes: mild AP, moderately severe AP, and severe AP. […] The diagnosis of acute pancreatitis is based on blood tests to determine the level of serum lipase and amylase and imaging techniques: magnetic resonance cholangiopancreatography (MRCP), CT, and US.

• #4 Acute Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1101/p632.html

  Acute pancreatitis is most commonly caused by gallstones or chronic alcohol use, and accounts for more than 200,000 hospital admissions annually. Using the Atlanta criteria, acute pancreatitis is diagnosed when a patient presents with two of three findings, including abdominal pain suggestive of pancreatitis, serum amylase and/or lipase levels at least three times the normal level, and characteristic findings on imaging. […] Contrast-enhanced computed tomography is considered the diagnostic standard for radiologic evaluation of acute pancreatitis because of its success in predicting disease severity and prognosis. […] Using the Atlanta criteria, acute pancreatitis is diagnosed when a patient presents with two of three findings, including abdominal pain suggestive of pancreatitis, serum amylase and/or lipase levels at least three times the normal level, and characteristic findings on imaging.

• #5 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  At least two of the following symptoms must be present for a diagnosis of acute pancreatitis: abdominal pain, described as a persistent and severe epigastric pain often radiating to the back with acute onset; activity of the serum lipase or amylase at least three times greater than the upper limit of normal; and the characteristic symptoms of acute pancreatitis detected by ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI). […] […] The etiology of AP should be determined on admission. Early initiation of diagnostics to determine the etiology increases the probability of stating a proper diagnosis. Moreover, it enables the implementation of appropriate treatment and methods to prevent complications and allows the taking of measures to prevent subsequent attacks of pancreatitis. The etiology is defined on the basis of a detailed personal and family history of pancreatic disease, physical examination, laboratory serum tests, and imaging. Another measure that should be taken on admission is to predict the outcome of the AP. It is advised to evaluate host risk factors, clinical risk, and response to initial therapy. […]

• #6 Acute Pancreatitis | Choose the Right Test

  https://arupconsult.com/content/pancreatitis-acute

  Laboratory testing for acute pancreatitis is appropriate to support the diagnosis in patients with suspected acute pancreatitis and to contribute to prognosis. […] According to the American College of Gastroenterology clinical practice guidelines, the definitive diagnosis of acute pancreatitis requires two of the criteria in the table below: Epigastric abdominal pain, Elevated lipase or amylase concentration 3x upper limit of normal, Imaging findings of pancreatic inflammation. […] The best test for acute pancreatitis is the serum lipase test. If the lipase concentration is 3x the upper limit of normal, a diagnosis of acute pancreatitis is highly likely. […] Amylase measurement is no longer recommended for the diagnosis of acute pancreatitis. […] Several systems exist for estimating severity and assessing prognosis of acute pancreatitis, although there is no clinical agreement on which should be utilized.

• #7 Acute pancreatitis – Wikipedia

  https://en.wikipedia.org/wiki/Acute_pancreatitis

  Acute pancreatitis is diagnosed using clinical history and physical examination findings supporting the diagnosis with imaging and pancreatic enzymes (amylase and lipase). The Revised Atlanta Classification requires two out of three of the following findings for the diagnosis: abdominal pain consistent with pancreatitis, elevated amylase or lipase levels greater than 3 times the upper limit of normal, and imaging consistent with acute pancreatitis. Additional labs may be used to identify organ failure for prognostic purposes or to guide fluid resuscitation rate. If the lipase level is about 2.5 to 3 times that of amylase, it is an indication of pancreatitis due to alcohol. Serum lipase is more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis, and is the preferred test in the diagnosis.

• #8 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  According to a clinical practice guideline, published in 2016 by Greenberg et al., concerning the management of acute pancreatitis, in all patients with suspicion of acute pancreatitis a level of serum lipase should be tested because of its slightly higher sensitivity in comparison with other serum and urine tests. The diagnosis of acute pancreatitis is made when a serum lipase activity is at least three times greater than the upper limit of normal. […] […] The first two are present in the most of patients, whereas the latter occurs slightly less frequently. Due to that, in the vast majority of cases, diagnosis of AP can already be established on the basis of abdominal pain and an elevation of pancreatic enzymes. […] […] The revised Atlanta classification system from 2012, defining the clinical diagnosis, CT manifestations, and the disease course of acute pancreatitis, distinguishes two morphologic subtypes of AP: interstitial oedematous pancreatitis and necrotizing pancreatitis. […]

• #9 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct. […] Stool tests can measure levels of fat that could suggest your digestive system isn’t absorbing nutrients as it should. […] Your doctor may recommend other tests, depending on your symptoms or other conditions you may have.

• #10 Diagnosis of Pancreatitis – NIDDK

  https://www.niddk.nih.gov/health-information/digestive-diseases/pancreatitis/diagnosis

  To diagnose pancreatitis and find its causes, doctors use your medical history, a physical exam, lab and imaging tests. […] Health care professionals may use lab or imaging tests to diagnose pancreatitis and find its causes. Diagnosing chronic pancreatitis can be hard in the early stages. Your doctor will also test for other conditions that have similar symptoms, such as peptic ulcers or pancreatic cancer. […] Lab tests to help diagnose pancreatitis include the following: Blood tests. A health care professional may take a blood sample from you and send the sample to a lab to test for high amylase and lipase levels, high blood glucose, high levels of blood fats, signs of infection or inflammation of the bile ducts, pancreas, gallbladder, or liver, pancreatic cancer. […] Health care professionals also use imaging tests to diagnose pancreatitis.

• #11 Acute pancreatitis – Symptoms, diagnosis and treatment | BMJ Best Practice

  https://bestpractice.bmj.com/topics/en-gb/3000118

  Acute pancreatitis typically presents with severe sudden-onset mid-epigastric or left upper quadrant abdominal pain, which often radiates to the back. Nausea and vomiting is seen in 80% of patients. […] The diagnosis is confirmed in most patients by elevated serum lipase or amylase (3 times upper limit of normal). Contrast-enhanced computed tomography (CECT) is only required where there is diagnostic doubt or a failure to improve within 72 to 96 hours from onset of symptoms. […] Diagnostic investigations include serum lipase or amylase, FBC and differential, C-reactive protein (CRP), urea/creatinine, pulse oximetry, LFTs, CXR, transabdominal ultrasound, and serum calcium. […] Investigations to consider include serum triglycerides, abdominal CT scan (CECT), endoscopic ultrasound (EUS), magnetic resonance cholangiopancreatography (MRCP), and arterial blood gas. […] Emerging tests include urinary trypsinogen-2 and serum IL-6 and IL-8.

• #12 Acute Pancreatitis: Mechanisms, Diagnosis, and Management – Gastroenterology Advisor

  https://www.gastroenterologyadvisor.com/features/acute-pancreatitis/

  Although the clinical presentation of acute pancreatitis may vary, the most common presenting symptom occurring in 95% of cases is deep epigastric pain that radiates to the back. […] The diagnosis of acute pancreatitis is largely based on a patients history and clinical presentation; laboratory and imaging studies may be used to confirm a clinical suspicion. The Revised Atlanta Classification requires at least 2 of the following criteria be met to confirm a diagnosis of acute pancreatitis: Acute upper abdominal pain, Serum lipase or amylase levels greater than 3 times the upper normal limit, Findings consistent with acute pancreatitis on imaging. […] Imaging is not necessary unless laboratory values are inconclusive or the clinician is concerned about severe complications such as a peripancreatic fluid collection, necrosis, pancreatic pseudocyst, hemorrhage, abscess, or pancreatic fistula. Computed tomography (CT) scan of the abdomen with intravenous contrast is the study of choice for severe cases of acute pancreatitis. […] Endoscopic ultrasound is a minimally invasive outpatient procedure that produces high-resolution real-time images that may be used for the diagnosis and management of pancreatic and biliary diseases.

• #13

  https://www.nhs.uk/conditions/acute-pancreatitis/diagnosis/

  Acute pancreatitis is usually diagnosed in hospital, where you’ll receive treatment and be monitored for any complications. […] A doctor will ask you about your symptoms, family history and may feel your tummy it will be very tender if you have acute pancreatitis. […] They’ll also do a blood test, and sometimes a CT scan, to help confirm the diagnosis. […] At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You’ll be monitored closely for signs of serious problems, such as organ failure. […] You may have further tests to help determine the severity of your condition and assess your risk of developing more serious complications. These may include: a CT scan where a series of X-rays are taken to build up a more detailed image of your pancreas, an MRI scan where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body, an ultrasound scan where sound waves are used to create a picture of your gallbladder to detect gallstones, and a picture of your pancreas.

• #14 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  To predict the severity and mortality of AP, clinical data (including assessment of organ function) are assessed, laboratory tests and imaging are performed, and severity-of-the-disease rating systems are used. Those measures should be taken on admission and at 48 h. […] […] According to the recommendations, the diagnosis of acute pancreatitis is based on blood tests to determine the level of serum lipase and amylase and imaging techniques: magnetic resonance cholangiopancreatography (MRCP), CT, and US. Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP. Currently, no biochemical test has been identified that fulfills the above-mentioned criteria and can be considered the „gold standard” for the diagnosis and evaluation of the severity of AP. […]

• #15 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  Nonetheless, the relevant and currently commonly used laboratory tests in the diagnosis of AP are serum lipase and serum amylase. […] According to a clinical practice guideline, published in 2016 by Greenberg et al., concerning the management of acute pancreatitis, in all patients with suspicion of acute pancreatitis a level of serum lipase should be tested because of its slightly higher sensitivity in comparison with other serum and urine tests. […] The diagnosis of acute pancreatitis is made when a serum lipase activity is at least three times greater than the upper limit of normal. […] A serum amylase test is also performed in the diagnostics of AP, but it has a lower clinical value. […] The key blood biochemical parameter in the detection of acute pancreatitis is a serum lipase, which is characterized by an earlier and longer-lasting elevation than a serum amylase.

• #16 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  Nonetheless, the relevant and currently commonly used laboratory tests in the diagnosis of AP are serum lipase and serum amylase. […] According to a clinical practice guideline, published in 2016 by Greenberg et al., concerning the management of acute pancreatitis, in all patients with suspicion of acute pancreatitis a level of serum lipase should be tested because of its slightly higher sensitivity in comparison with other serum and urine tests. […] The diagnosis of acute pancreatitis is made when a serum lipase activity is at least three times greater than the upper limit of normal. […] A serum amylase test is also performed in the diagnostics of AP, but it has a lower clinical value. […] The key blood biochemical parameter in the detection of acute pancreatitis is a serum lipase, which is characterized by an earlier and longer-lasting elevation than a serum amylase.

• #17 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  According to a clinical practice guideline, published in 2016 by Greenberg et al., concerning the management of acute pancreatitis, in all patients with suspicion of acute pancreatitis a level of serum lipase should be tested because of its slightly higher sensitivity in comparison with other serum and urine tests. The diagnosis of acute pancreatitis is made when a serum lipase activity is at least three times greater than the upper limit of normal. […] […] The first two are present in the most of patients, whereas the latter occurs slightly less frequently. Due to that, in the vast majority of cases, diagnosis of AP can already be established on the basis of abdominal pain and an elevation of pancreatic enzymes. […] […] The revised Atlanta classification system from 2012, defining the clinical diagnosis, CT manifestations, and the disease course of acute pancreatitis, distinguishes two morphologic subtypes of AP: interstitial oedematous pancreatitis and necrotizing pancreatitis. […]

• #18 Acute Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1101/p632.html

  Lipase level testing is more sensitive and specific than measuring amylase levels, because amylase is also produced by the salivary glands and levels may be normal in patients with recurrent alcoholic pancreatitis. Lipase or amylase levels greater than three times the normal amount are considered diagnostic for pancreatitis. […] Contrast-enhanced computed tomography (CT) is considered the diagnostic standard for radiologic evaluation of acute pancreatitis because it has demonstrated success in the prediction of disease severity and prognosis.

• #19 Acute Pancreatitis | Choose the Right Test

  https://arupconsult.com/content/pancreatitis-acute

  Acute pancreatitis is a reversible inflammatory process of the pancreas caused by auto digestion that generally presents with epigastric abdominal pain that may radiate to the back and is worsened by the ingestion of food. […] In addition to abdominal pain, patients may present with nausea and vomiting, which are nonspecific in most cases, so imaging and laboratory testing are important for definitive diagnosis. Lipase is the preferred laboratory test for diagnosing acute pancreatitis, as it is the most sensitive and specific marker for pancreatic cell damage. […] The best test for diagnosis of acute pancreatitis is lipase. If lipase is more than three times the upper limit of normal, it is highly likely that the patient has acute pancreatitis. […] Imaging can contribute to the diagnosis of acute pancreatitis and enable assessment for local complications.

• #20 Blood tests for acute pancreatitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/blood-tests-for-acute-pancreatitis.html

  The diagnosis of acute pancreatitis requires the presence of at least two of the three diagnostic criteria characteristic abdominal pain, elevated serum amylase or lipase, and radiological evidence of pancreatitis. […] Serum concentrations of amylase and lipase rise within hours of the pancreatic injury. A threshold concentration 24 times the upper limit of normal is recommended for diagnosis. […] Serum lipase is now the preferred test due to its improved sensitivity, particularly in alcohol-induced pancreatitis. Its prolonged elevation creates a wider diagnostic window than amylase. […] The diagnosis of acute pancreatitis usually requires a combination of clinical, laboratory and radiological findings. A number of international guidelines have suggested two of the following three features are required for the diagnosis: abdominal pain consistent with acute pancreatitis (acute onset of persistent severe epigastric pain often radiating to the back), serum lipase activity (or amylase activity) at least three times greater than the upper limit of normal, characteristic findings of acute pancreatitis on abdominal ultrasound (a CT scan or MRI is considered if the diagnosis is uncertain).

• #21 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  The measurement of both serum lipase and serum amylase does not demonstrate advantages in either treatment or profitability. […] The study by Rompianesi et al. compared the diagnostic exactness of serum lipase, serum amylase, urinary amylase, and urinary trypsinogen-2 in the diagnosis of AP. […] The diagnosis of AP by the usage of an MRI is dependent on the occurrence of morphologic and peripancreatic changes. […] The diagnosis of AP is as important as the diagnosis of the etiology of AP, which in many cases is associated with an inadequate workup.

• #22 Blood tests for acute pancreatitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/blood-tests-for-acute-pancreatitis.html

  Serum concentrations of amylase and lipase rise within hours of an episode of acute pancreatitis. They are key components of the diagnostic criteria along with abdominal pain and radiological findings. […] Lipase is now preferred over amylase due to a higher sensitivity, particularly in cases of pancreatitis due to alcohol and hypertriglyceridaemia. It also tends to remain elevated for longer than amylase, making it more useful when the presentation has been delayed by more than 24 hours.

• #23 Blood tests for acute pancreatitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/blood-tests-for-acute-pancreatitis.html

  Lipase has now replaced amylase as the biochemical test of choice in acute pancreatitis. […] Serum lipase typically increases 36 hours after the onset of acute pancreatitis and usually peaks at 24 hours. […] The magnitude of the elevation of amylase and lipase does not predict disease severity in adults. […] A serum C-reactive protein (CRP) greater than 150 mg/L measured 48 hours after the onset of symptoms is the best single laboratory predictor of disease severity. […] Trypsinogen is the best studied, with concentrations rising in the serum and urine within a few hours of the onset of pancreatitis. The sensitivity is estimated to be over 90% and the specificity is over 83%. However, this test along with most of the other new biomarkers appears to offer little advantage over lipase and amylase in terms of diagnostic accuracy.

• #24 Diagnosis and Management of Acute Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2000/0701/p164.html

  Lipase levels increase within four to eight hours of the onset of clinical symptoms and peak at about 24 hours. Levels decrease within eight to 14 days. The specificity (50 to 99 percent) and sensitivity (86 to 100 percent) of lipase measurements are better than those of amylase measurement, particularly in detecting alcoholic pancreatitis. […] Based on median sensitivities and specificities, an elevated trypsin level has a better likelihood ratio for detecting pancreatitis than the amylase level and is probably the most accurate serum indicator for acute pancreatitis. […] The treatment of pancreatitis may be conservative or complex, depending on the severity of the presentation and the development of complications. A patient with a history and physical examination consistent with pancreatitis should have laboratory studies, including determination of amylase, lipase and, if available, serum trypsin levels to confirm the diagnosis. […] Establishing a rapid diagnosis through laboratory testing and radiologic studies is important.

• #25 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] The above-mentioned imaging techniques provide crucial information for the diagnosis and the course of the disease. […] Specifically, ultrasonography is recommended as a first and basic imaging test performed in patients with suspected AP in order to confirm or exclude the diagnosis as well as detect the possible cause of the disease, while MRI and CT are useful in diagnosing local complications and discovering the necrosis of the pancreas or in assessing the severity of the AP. […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP.

• #26 Blood tests for acute pancreatitis – Australian Prescriber

  https://australianprescriber.tg.org.au/articles/blood-tests-for-acute-pancreatitis.html

  Lipase has now replaced amylase as the biochemical test of choice in acute pancreatitis. […] Serum lipase typically increases 36 hours after the onset of acute pancreatitis and usually peaks at 24 hours. […] The magnitude of the elevation of amylase and lipase does not predict disease severity in adults. […] A serum C-reactive protein (CRP) greater than 150 mg/L measured 48 hours after the onset of symptoms is the best single laboratory predictor of disease severity. […] Trypsinogen is the best studied, with concentrations rising in the serum and urine within a few hours of the onset of pancreatitis. The sensitivity is estimated to be over 90% and the specificity is over 83%. However, this test along with most of the other new biomarkers appears to offer little advantage over lipase and amylase in terms of diagnostic accuracy.

• #27 Acute pancreatitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-pancreatitis/

  Simultaneously conduct tests to establish the diagnosis, assess severity, and rule out differential diagnoses of acute abdominal pain. […] Acute pancreatitis is a medical emergency; begin fluid resuscitation as soon as it is suspected. […] The degree of lipase and/or amylase elevation does not necessarily correlate with the severity of or prognosis for acute pancreatitis. […] Measure serum triglycerides promptly after symptom onset, as levels decrease rapidly with fasting. […] Determining calcium values is very important: Hypercalcemia may cause pancreatitis, which may then, in turn, cause hypocalcemia! […] Abdominal ultrasound for suspected acute pancreatitis is primarily used to identify gallstones as features of acute pancreatitis are only visible in approximately 20% of cases.

• #28

  https://link.springer.com/article/10.1007/s40265-022-01766-4

  Initial investigations for suspected acute pancreatitis include serum amylase and/or lipase, triglycerides and lipid panel, full blood count, renal and liver function tests, glucose, HbA1c, calcium and TUS. […] If the diagnosis remains uncertain, whether amylase and/or lipase are elevated or not, MRI or CT are indicated to identify features of acute pancreatitis (swelling of the pancreas, inflammatory fat stranding, peri-pancreatic fluid collections) or any other diagnosis. […] C-reactive protein is a useful biomarker to gauge the level of systemic inflammatory response syndrome that may be accompanied by organ dysfunction, but elevation may take at least 48 h, so measurement is best delayed until the day after admission.

• #29 Acute Pancreatitis Workup: Approach Considerations, Laboratory Studies, Abdominal Radiography

  https://emedicine.medscape.com/article/181364-workup

  Serum amylase and lipase levels are typically elevated in persons with acute pancreatitis. However, these elevations may only indicate pancreastasis. In research studies, amylase or lipase levels at least 3 times above the reference range are generally considered diagnostic of acute pancreatitis. […] Determine alkaline phosphatase, total bilirubin, aspartate aminotransferase (AST), and alanine aminotransferase (ALT) levels to search for evidence of gallstone pancreatitis. An ALT level higher than 150 U/L suggests gallstone pancreatitis and a more fulminant disease course. […] A C-reactive protein (CRP) value can be obtained 24-48 hours after presentation to provide some indication of prognosis. Higher levels have been shown to correlate with a propensity toward organ failure. A CRP value in double figures (ie, 10 mg/dL) strongly indicates severe pancreatitis.

• #30 Acute Pancreatitis | Choose the Right Test

  https://arupconsult.com/content/pancreatitis-acute

  C-reactive protein (CRP) concentrations 150 mg/dL within the first 48 hours after disease presentation suggest acute necrotizing pancreatitis. […] Procalcitonin measurement may help differentiate between mild and severe disease and should be obtained early in illness. […] Trypsin levels are indicative of pancreatic damage. Concentrations are significantly elevated in acute pancreatitis.

• #31

  https://link.springer.com/article/10.1007/s40265-022-01766-4

  Initial investigations for suspected acute pancreatitis include serum amylase and/or lipase, triglycerides and lipid panel, full blood count, renal and liver function tests, glucose, HbA1c, calcium and TUS. […] If the diagnosis remains uncertain, whether amylase and/or lipase are elevated or not, MRI or CT are indicated to identify features of acute pancreatitis (swelling of the pancreas, inflammatory fat stranding, peri-pancreatic fluid collections) or any other diagnosis. […] C-reactive protein is a useful biomarker to gauge the level of systemic inflammatory response syndrome that may be accompanied by organ dysfunction, but elevation may take at least 48 h, so measurement is best delayed until the day after admission.

• #32 The clinical characteristics of focal acute pancreatitis based on imaging diagnosis: comparison with non-localized acute pancreatitis- a preliminary result | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-023-03015-8

  For differences in etiology composition, clinical manifestations, laboratory tests between focal AP and non-localized AP, as far as we know, there are no relevant reports. […] The study found that changes in symptoms, signs and laboratory indicators of focal AP are not obvious, when compared with non-localized AP, however, there was no significant difference in the severity of the two groups. […] In this study, we found that there are statistically significant differences in neutrophil ratio, D-dimer, -glutamyltransferase (GGT), amylase, and lipase between the two groups. […] The peripheral blood neutrophil ratio in non-localized AP group was significantly higher than that in focal AP group, indicating that the inflammatory response of the former was more intense and more influential than that of the latter.

• #33 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] The above-mentioned imaging techniques provide crucial information for the diagnosis and the course of the disease. […] Specifically, ultrasonography is recommended as a first and basic imaging test performed in patients with suspected AP in order to confirm or exclude the diagnosis as well as detect the possible cause of the disease, while MRI and CT are useful in diagnosing local complications and discovering the necrosis of the pancreas or in assessing the severity of the AP. […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP.

• #34 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] The above-mentioned imaging techniques provide crucial information for the diagnosis and the course of the disease. […] Specifically, ultrasonography is recommended as a first and basic imaging test performed in patients with suspected AP in order to confirm or exclude the diagnosis as well as detect the possible cause of the disease, while MRI and CT are useful in diagnosing local complications and discovering the necrosis of the pancreas or in assessing the severity of the AP. […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP.

• #35

  https://www.nhs.uk/conditions/acute-pancreatitis/diagnosis/

  Acute pancreatitis is usually diagnosed in hospital, where you’ll receive treatment and be monitored for any complications. […] A doctor will ask you about your symptoms, family history and may feel your tummy it will be very tender if you have acute pancreatitis. […] They’ll also do a blood test, and sometimes a CT scan, to help confirm the diagnosis. […] At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You’ll be monitored closely for signs of serious problems, such as organ failure. […] You may have further tests to help determine the severity of your condition and assess your risk of developing more serious complications. These may include: a CT scan where a series of X-rays are taken to build up a more detailed image of your pancreas, an MRI scan where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body, an ultrasound scan where sound waves are used to create a picture of your gallbladder to detect gallstones, and a picture of your pancreas.

• #36 Diagnosing Pancreatitis | NYU Langone Health

  https://nyulangone.org/conditions/pancreatitis/diagnosis

  NYU Langone specialists diagnose pancreatitis, a disease in which the pancreas becomes inflamed, causing abdominal pain, tissue damage, and problems with digestion. […] To diagnose acute pancreatitis, NYU Langone gastroenterologists take your medical history and ask about your symptoms. […] Our specialists often perform multiple diagnostic tests to confirm the diagnosis of pancreatitis with certainty. […] Pancreatitis is considered chronic if the pancreas remains inflamed despite treatment; this may be confirmed with follow-up diagnostic tests. […] Your doctor may draw a small amount of blood to check the levels of the digestive enzymes amylase and lipase. Elevated levels meaning at least a threefold increase is a sign of pancreatitis. […] An ultrasound may reveal a dilated bile duct, which may indicate a blockage a common cause of acute pancreatitis.

• #37 Acute Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371613-overview

  According to the revised Atlanta Classification, 2 out of 3 features are required for diagnosing acute pancreatitis: (1) acute-onset upper abdominal pain radiating to the back; (2) serum lipase or amylase levels 3 or more times higher than the normal range; and (3) classical imaging findings consistent with acute pancreatitis. […] Contrast-enhanced computed tomography (CECT) is the standard imaging modality for the evaluation of acute pancreatitis and its complications. […] The usefulness of CECT is limited in patients who are allergic to intravenous (IV) contrast or have renal insufficiency. […] Other adjunctive imaging modalities include ultrasonography (US), MRI, and angiography. […] In the emergency departments, the imaging modalities of choice are CT and ultrasound because of access, speed, and cost.

• #38 Acute pancreatitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-pancreatitis/

  Simultaneously conduct tests to establish the diagnosis, assess severity, and rule out differential diagnoses of acute abdominal pain. […] Acute pancreatitis is a medical emergency; begin fluid resuscitation as soon as it is suspected. […] The degree of lipase and/or amylase elevation does not necessarily correlate with the severity of or prognosis for acute pancreatitis. […] Measure serum triglycerides promptly after symptom onset, as levels decrease rapidly with fasting. […] Determining calcium values is very important: Hypercalcemia may cause pancreatitis, which may then, in turn, cause hypocalcemia! […] Abdominal ultrasound for suspected acute pancreatitis is primarily used to identify gallstones as features of acute pancreatitis are only visible in approximately 20% of cases.

• #39 Acute Pancreatitis | AAFP

  https://www.aafp.org/pubs/afp/issues/2014/1101/p632.html

  Acute pancreatitis is most commonly caused by gallstones or chronic alcohol use, and accounts for more than 200,000 hospital admissions annually. Using the Atlanta criteria, acute pancreatitis is diagnosed when a patient presents with two of three findings, including abdominal pain suggestive of pancreatitis, serum amylase and/or lipase levels at least three times the normal level, and characteristic findings on imaging. […] Contrast-enhanced computed tomography is considered the diagnostic standard for radiologic evaluation of acute pancreatitis because of its success in predicting disease severity and prognosis. […] Using the Atlanta criteria, acute pancreatitis is diagnosed when a patient presents with two of three findings, including abdominal pain suggestive of pancreatitis, serum amylase and/or lipase levels at least three times the normal level, and characteristic findings on imaging.

• #40 Acute Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371613-overview

  According to the revised Atlanta Classification, 2 out of 3 features are required for diagnosing acute pancreatitis: (1) acute-onset upper abdominal pain radiating to the back; (2) serum lipase or amylase levels 3 or more times higher than the normal range; and (3) classical imaging findings consistent with acute pancreatitis. […] Contrast-enhanced computed tomography (CECT) is the standard imaging modality for the evaluation of acute pancreatitis and its complications. […] The usefulness of CECT is limited in patients who are allergic to intravenous (IV) contrast or have renal insufficiency. […] Other adjunctive imaging modalities include ultrasonography (US), MRI, and angiography. […] In the emergency departments, the imaging modalities of choice are CT and ultrasound because of access, speed, and cost.

• #41 The Radiology Assistant : Acute Pancreatitis

  https://radiologyassistant.nl/abdomen/pancreas/acute-pancreatitis

  Early severity stratification of acute pancreatitis is important to identify patients with the highest morbidity. […] The 2012 Revised Atlanta Classification discerns 4 types of peripancreatic fluid collections in acute pancreatitis depending on the content, degree of encapsulation and time. […] On CT, the discrimination between an APFC and ANC may be difficult, especially in the first weeks and the term „indeterminate peripancreatic collections” can be used. […] The CT severity index (CTSI) combines the Balthazar grade (0-4 points) with the extent of pancreatic necrosis (0-6 points) on a 10-point severity scale. […] CT is the imaging modality of choice for the diagnosis and staging of acute pancreatitis and its complications. […] Since the diagnosis of acute pancreatitis is usually made on clinical and laboratory findings, an early CT is only recommended when the diagnosis is uncertain, or in case of suspected early complications such as bowel perforation or ischemia.

• #42 Acute pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-pancreatitis?lang=us

  The role of imaging is manifold: to clarify the diagnosis when the clinical picture is confusing, to assess severity (e.g. Balthazar score) and thus to determine prognosis, to detect complications, to determine possible causes. […] Imaging studies of acute pancreatitis may be normal in mild cases. Contrast-enhanced CT provides the most comprehensive initial assessment, typically with a dual-phase (arterial and portal venous) protocol. […] However, ultrasound is useful for the follow-up of specific abnormalities, such as fluid collections and pseudocysts. […] CT is used to grade the severity of pancreatitis, following scoring systems can be used: Modified CT severity index, CT severity index, Balthazar score. […] Contrast-enhanced MR is equivalent to CT in the assessment of acute pancreatitis.

• #43

  https://journals.lww.com/jpancreatology/fulltext/2021/06000/guidelines_for_the_diagnosis_and_treatment_of.2.aspx

  The typical imaging findings of CT provide an important basis for the diagnosis of AP, but the initial imaging features cannot reflect the severity of the disease. […] Recommendation 2: Contrast-enhanced CT is not recommended at the initial stage of AP unless it is needed for diagnosis (quality of evidence: moderate; strength of recommendation: strong). […] Recommendation 3: Patients with suspected biliary AP should be routinely examined by ultrasonography on admission or at the initial stage of the disease to determine whether there are biliary stones (quality of evidence: moderate; strength of recommendation: strong). […] The commonly used classification of AP severity includes the revised Atlanta classification (RAC) and the determinant-based classification (DBC). […] Recommendation 4: Both RAC and DBC classifications can be applied to classify AP severity, and there is no significant difference between them in terms of predicting mortality, ICU occupancy rate, and ICU hospitalization time (quality of evidence: moderate; strength of recommendation: strong).

• #44 Acute pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-pancreatitis?lang=us

  The diagnosis of acute pancreatitis is usually based on clinical criteria or a combination of clinical and radiographic features. […] Two of the following three criteria are required for the diagnosis: acute onset of persistent, severe epigastric pain (i.e. pain consistent with acute pancreatitis), lipase/amylase elevation 3 times the upper limit of normal, characteristic imaging features on contrast-enhanced CT, MRI, or ultrasound. […] Elevation of serum amylase and lipase are 90-95% specific for the diagnosis. […] A normal amylase level (normoamylasaemia) in acute pancreatitis is well-recognized, especially when it occurs on a background of chronic pancreatitis. […] A normal lipase level has also been reported (10 case reports) but is extremely rare. […] The optimal timing of initial CT imaging is at least 72-96 hours after the onset of symptoms. Early CT scan can lead to underestimation of parenchymal involvement and fail to detect the degree of pancreatic necrosis.

• #45 Acute pancreatitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-pancreatitis/

  CT abdomen is not routinely required to establish a diagnosis of acute pancreatitis. If performed to evaluate for necrotic pancreatitis, the optimal timing to perform a CT abdomen is at least 57 days after symptom onset. […] Suspect pancreatic tumor as the underlying cause for idiopathic acute pancreatitis in patients aged 40 years. […] Use adult diagnostic criteria for acute pancreatitis. […] Serum lipase is more reliable than amylase in infants. […] Abdominal ultrasound is the preferred initial imaging modality.

• #46

  https://www.nhs.uk/conditions/acute-pancreatitis/diagnosis/

  Acute pancreatitis is usually diagnosed in hospital, where you’ll receive treatment and be monitored for any complications. […] A doctor will ask you about your symptoms, family history and may feel your tummy it will be very tender if you have acute pancreatitis. […] They’ll also do a blood test, and sometimes a CT scan, to help confirm the diagnosis. […] At first, it can be difficult to tell whether your acute pancreatitis is mild or severe. You’ll be monitored closely for signs of serious problems, such as organ failure. […] You may have further tests to help determine the severity of your condition and assess your risk of developing more serious complications. These may include: a CT scan where a series of X-rays are taken to build up a more detailed image of your pancreas, an MRI scan where strong magnetic fields and radio waves are used to produce a detailed image of the inside of your body, an ultrasound scan where sound waves are used to create a picture of your gallbladder to detect gallstones, and a picture of your pancreas.

• #47 Diagnosing Pancreatitis | NYU Langone Health

  https://nyulangone.org/conditions/pancreatitis/diagnosis

  A CT scan involves taking a series of X-rays from different angles to show clear images of the bones and soft tissues, including organs in the abdomen. […] Magnetic resonance cholangiopancreatography is a special type of MRI scan that allows doctors to examine detailed images of the gallbladder, pancreas, and their connective ducts. […] This test can reveal gallstones in the bile duct. […] The ultrasound probe uses sound waves to produce images of the body that appear on a computer monitor. Your doctor can detect gallstones or signs of chronic pancreatitis, such as damage to the pancreatic tissue, with this test.

• #48 Acute pancreatitis | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/acute-pancreatitis?lang=us

  The role of imaging is manifold: to clarify the diagnosis when the clinical picture is confusing, to assess severity (e.g. Balthazar score) and thus to determine prognosis, to detect complications, to determine possible causes. […] Imaging studies of acute pancreatitis may be normal in mild cases. Contrast-enhanced CT provides the most comprehensive initial assessment, typically with a dual-phase (arterial and portal venous) protocol. […] However, ultrasound is useful for the follow-up of specific abnormalities, such as fluid collections and pseudocysts. […] CT is used to grade the severity of pancreatitis, following scoring systems can be used: Modified CT severity index, CT severity index, Balthazar score. […] Contrast-enhanced MR is equivalent to CT in the assessment of acute pancreatitis.

• #49 Acute Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371613-overview

  According to the revised Atlanta Classification, 2 out of 3 features are required for diagnosing acute pancreatitis: (1) acute-onset upper abdominal pain radiating to the back; (2) serum lipase or amylase levels 3 or more times higher than the normal range; and (3) classical imaging findings consistent with acute pancreatitis. […] Contrast-enhanced computed tomography (CECT) is the standard imaging modality for the evaluation of acute pancreatitis and its complications. […] The usefulness of CECT is limited in patients who are allergic to intravenous (IV) contrast or have renal insufficiency. […] Other adjunctive imaging modalities include ultrasonography (US), MRI, and angiography. […] In the emergency departments, the imaging modalities of choice are CT and ultrasound because of access, speed, and cost.

• #50 Pancreatitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/pancreatitis/diagnosis-treatment/drc-20360233

  Your healthcare professional will ask you questions about your health history and symptoms, give you a general physical, and check for pain or tenderness in your belly. […] Tests and procedures that may be used include the following. […] Blood tests can give clues about how the immune system, pancreas and related organs are working. […] Ultrasound images can show gallstones in the gallbladder or inflammation of the pancreas. […] Computerized tomography (CT) scan show gallstones and the extent of inflammation. […] Magnetic resonance imaging (MRI) to look for irregular tissues or structures in the gallbladder, pancreas and bile ducts. […] Endoscopic ultrasound is an ultrasound device on a small tube fed through the mouth and into the digestive system. It can show inflammation, gallstones, cancer, and blockages in the pancreatic duct or bile duct. […] Stool tests can measure levels of fat that could suggest your digestive system isn’t absorbing nutrients as it should. […] Your doctor may recommend other tests, depending on your symptoms or other conditions you may have.

• #51 Diagnosing Pancreatitis | NYU Langone Health

  https://nyulangone.org/conditions/pancreatitis/diagnosis

  A CT scan involves taking a series of X-rays from different angles to show clear images of the bones and soft tissues, including organs in the abdomen. […] Magnetic resonance cholangiopancreatography is a special type of MRI scan that allows doctors to examine detailed images of the gallbladder, pancreas, and their connective ducts. […] This test can reveal gallstones in the bile duct. […] The ultrasound probe uses sound waves to produce images of the body that appear on a computer monitor. Your doctor can detect gallstones or signs of chronic pancreatitis, such as damage to the pancreatic tissue, with this test.

• #52 A Look at the Diagnosis & Treatment of Acute Pancreatitis

  https://reachmd.com/programs/gi-insights/a-look-at-the-diagnosis-treatment-of-acute-pancreatitis/14233/

  Acute pancreatitis remains the leading cause of inpatient care among gastrointestinal conditions. What do we need to know about the diagnosis and treatment? […] An inability to explain the etiology of pancreatitis persists in about a quarter of patients after a typical workup. […] Both EUS and MRI with MRCP have been used for this purpose, and I would say that actually they have both been studied fairly extensively. Of the two, there are several direct comparisons, and when directly compared, EUS has been shown to demonstrate a potential cause for acute pancreatitis much more often than MRI. […] A recent meta-analysis actually showed an odds ratio of about 3.5 favoring EUS over MRI. […] Having said that though, there are a few caveats built into that. So first I would just offer that the sensitivity of EUS, for previously unknown explanation for pancreatitis is extremely variable throughout the literature. It ranges from 30 to 90 percent depending upon the context.

• #53 Acute Pancreatitis: Mechanisms, Diagnosis, and Management – Clinical Advisor

  https://www.clinicaladvisor.com/features/acute-pancreatitis/

  A MRCP allows for a noninvasive evaluation of the biliary and pancreatic ductal anatomy to identify parenchymal abnormalities such as duct dilation or stricture, cysts, and malignancies. […] Endoscopic ultrasound is a minimally invasive outpatient procedure that produces high-resolution real-time images that may be used for the diagnosis and management of pancreatic and biliary diseases.

• #54 A Look at the Diagnosis & Treatment of Acute Pancreatitis

  https://reachmd.com/programs/gi-insights/a-look-at-the-diagnosis-treatment-of-acute-pancreatitis/14233/

  Assessing the pancreas by EUS in the middle of an inflammatory episode, particularly one with a local complication like necrosis can really affect image quality, and none of the parenchymas may look as expected and may significantly bias the endoscopist. […] So, in concept, allowing the pancreas to calm down and return closer to its baseline should allow for better exams and more accuracy, but how much time is the right amount? […] We typically wait between two and six weeks after the initial injury to perform EUS. […] The current state of the literature actually favors surgical intervention for obstructive chronic pancreatitis. […] We now have actually three prospective randomized controlled trials that suggest that surgery has superior outcomes in terms of both partial, and complete pain relief, as compared to endoscopy.

• #55 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  To predict the severity and mortality of AP, clinical data (including assessment of organ function) are assessed, laboratory tests and imaging are performed, and severity-of-the-disease rating systems are used. Those measures should be taken on admission and at 48 h. […] […] According to the recommendations, the diagnosis of acute pancreatitis is based on blood tests to determine the level of serum lipase and amylase and imaging techniques: magnetic resonance cholangiopancreatography (MRCP), CT, and US. Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP. Currently, no biochemical test has been identified that fulfills the above-mentioned criteria and can be considered the „gold standard” for the diagnosis and evaluation of the severity of AP. […]

• #56 Acute Pancreatitis Workup: Approach Considerations, Laboratory Studies, Abdominal Radiography

  https://emedicine.medscape.com/article/181364-workup

  Various strategies have been used to predict the severity and outcome of acute pancreatitis, including the Ranson, Acute Physiology and Chronic Health Evaluation (APACHE) II, Glasgow, and Imrie scoring systems. […] A Ranson score of 0-2 has a minimal mortality, and the patient is admitted to the regular ward for medical therapy and support. A Ranson score of 3-5 has a 10%-20% mortality rate, and the patient should be admitted to the intensive care unit (ICU). A Ranson score higher than 5 after 48 hours has a mortality of more than 50% and is associated with more systemic complications.

• #57 Acute pancreatitis: A review of diagnosis, severity prediction and prognosis assessment from imaging technology, scoring system and artificial intelligence

  https://www.wjgnet.com/1007-9327/full/v29/i37/5268.htm

  Acute pancreatitis (AP) is a potentially life-threatening inflammatory disease of the pancreas, with clinical management determined by the severity of the disease. Diagnosis, severity prediction, and prognosis assessment of AP typically involve the use of imaging technologies, such as computed tomography, magnetic resonance imaging, and ultrasound, and scoring systems, including Ranson, Acute Physiology and Chronic Health Evaluation II, and Bedside Index for Severity in AP scores. […] Computed tomography is considered the gold standard imaging modality for AP due to its high sensitivity and specificity, while magnetic resonance imaging and ultrasound can provide additional information on biliary obstruction and vascular complications. Scoring systems utilize clinical and laboratory parameters to classify AP patients into mild, moderate, or severe categories, guiding treatment decisions, such as intensive care unit admission, early enteral feeding, and antibiotic use.

• #58 The Radiology Assistant : Acute Pancreatitis

  https://radiologyassistant.nl/abdomen/pancreas/acute-pancreatitis

  Early severity stratification of acute pancreatitis is important to identify patients with the highest morbidity. […] The 2012 Revised Atlanta Classification discerns 4 types of peripancreatic fluid collections in acute pancreatitis depending on the content, degree of encapsulation and time. […] On CT, the discrimination between an APFC and ANC may be difficult, especially in the first weeks and the term „indeterminate peripancreatic collections” can be used. […] The CT severity index (CTSI) combines the Balthazar grade (0-4 points) with the extent of pancreatic necrosis (0-6 points) on a 10-point severity scale. […] CT is the imaging modality of choice for the diagnosis and staging of acute pancreatitis and its complications. […] Since the diagnosis of acute pancreatitis is usually made on clinical and laboratory findings, an early CT is only recommended when the diagnosis is uncertain, or in case of suspected early complications such as bowel perforation or ischemia.

• #59 Acute Pancreatitis – National Pancreas Foundation

  https://pancreasfoundation.org/pancreas-disease/acute-pancreatitis/

  Diagnosis of pancreatic problems is often difficult, and treatments are therefore delayed because the organ is relatively inaccessible. […] Acute pancreatitis is confirmed by medical history, physical examination, and typically a blood test (amylase or lipase) for digestive enzymes of the pancreas. Blood amylase or lipase levels are typically elevated 3 times the normal level during acute pancreatitis. […] After diagnosis is confirmed, certain imaging tests might be performed during hospitalization or after to help identify the cause. […] Transabdominal Ultrasound […] Endoscopic ultrasound (EUS) […] Magnetic Resonance Cholangiopancreatography (MRCP) […] Computerized Tomography (CT) […] Several clinical risk-scoring systems are available to help physicians predict who is most likely to develop severe acute pancreatitis. […] Commonly used scoring systems include: The Bedside Index of Severity in Acute Pancreatitis (BISAP), The Ranson criteria, The APACHE II score.

• #60 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  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. […] The revised Atlanta classification system from 2012, defining the clinical diagnosis, CT manifestations, and the disease course of acute pancreatitis, distinguishes two morphologic subtypes of AP: interstitial oedematous pancreatitis and necrotizing pancreatitis. […] The aforementioned classification, evaluating additional local or systemic complications as well as the presence and duration of organ failure, divides AP into three subtypes: mild AP, moderately severe AP, and severe AP. […] The diagnosis of acute pancreatitis is based on blood tests to determine the level of serum lipase and amylase and imaging techniques: magnetic resonance cholangiopancreatography (MRCP), CT, and US.

• #61 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  According to a clinical practice guideline, published in 2016 by Greenberg et al., concerning the management of acute pancreatitis, in all patients with suspicion of acute pancreatitis a level of serum lipase should be tested because of its slightly higher sensitivity in comparison with other serum and urine tests. The diagnosis of acute pancreatitis is made when a serum lipase activity is at least three times greater than the upper limit of normal. […] […] The first two are present in the most of patients, whereas the latter occurs slightly less frequently. Due to that, in the vast majority of cases, diagnosis of AP can already be established on the basis of abdominal pain and an elevation of pancreatic enzymes. […] […] The revised Atlanta classification system from 2012, defining the clinical diagnosis, CT manifestations, and the disease course of acute pancreatitis, distinguishes two morphologic subtypes of AP: interstitial oedematous pancreatitis and necrotizing pancreatitis. […]

• #62 A narrative review of acute pancreatitis and its diagnosis, pathogenetic mechanism, and management

  https://atm.amegroups.org/article/view/59660/html

  Several scoring systems are also available to evaluate the severity of AP, including the Acute Physiology and Chronic Health Examination II score, the CT severity index (CTSI), the Harmless Acute Pancreatitis Score, and the Ranson score. […] AP can be classified as mild acute pancreatitis (MAP), moderately severe acute pancreatitis (MSAP), and severe acute pancreatitis (SAP). […] The optimal timing and method for the treatment of biliary stones in patients with acute biliary pancreatitis remain controversial. […] For patients with MAP, laparoscopic cholecystectomy is recommended during the initial period of hospitalization and may shorten the length of hospital stay and decrease the risk of gallstone recurrence. […] The academic community has continued to debate the utility of antibiotic prophylaxis in the management of AP.

• #63 Diagnosis and Treatment of Acute Pancreatitis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9406704/

  The etiology of AP should be determined on admission. Early initiation of diagnostics to determine the etiology increases the probability of stating a proper diagnosis. […] To predict the severity and mortality of AP, clinical data (including assessment of organ function) are assessed, laboratory tests and imaging are performed, and severity-of-the-disease rating systems are used. […] The management of the patient is based on the providing of supportive care, including, inter alia (in. al.), fluid resuscitation, pain control, and organ function assessment; ensuring adequate nutrition; and providing interventional treatments, such as cholecystectomy or endoscopic sphincterotomy, or necrosectomy in the case of necrotizing pancreatitis. […] This paper describes the available diagnostic methods used to diagnose AP and assess the subtype of AP, which is the severity of AP, and to present the management of the patient suffering from AP.

• #64 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  At least two of the following symptoms must be present for a diagnosis of acute pancreatitis: abdominal pain, described as a persistent and severe epigastric pain often radiating to the back with acute onset; activity of the serum lipase or amylase at least three times greater than the upper limit of normal; and the characteristic symptoms of acute pancreatitis detected by ultrasonography (US), computed tomography (CT), or magnetic resonance imaging (MRI). […] […] The etiology of AP should be determined on admission. Early initiation of diagnostics to determine the etiology increases the probability of stating a proper diagnosis. Moreover, it enables the implementation of appropriate treatment and methods to prevent complications and allows the taking of measures to prevent subsequent attacks of pancreatitis. The etiology is defined on the basis of a detailed personal and family history of pancreatic disease, physical examination, laboratory serum tests, and imaging. Another measure that should be taken on admission is to predict the outcome of the AP. It is advised to evaluate host risk factors, clinical risk, and response to initial therapy. […]

• #65 Current Diagnosis and Treatment of Acute Pancreatitis in Korea: A Nationwide Survey

  https://www.gutnliver.org/journal/view.html?uid=2184&vmd=Full

  Acute pancreatitis (AP) is a leading cause of emergency hospitalization. We present the current diagnostic and therapeutic status of AP as revealed by analysis of a large multicenter dataset. The medical records of patients diagnosed with AP between 2018 and 2019 in 12 tertiary medical centers in Korea were retrospectively reviewed. The most common etiologies of AP were biliary issues (41.6%) and alcohol consumption (24.6%), followed by hypertriglyceridemia (6.8%). The etiology was not identified in 111 (16.4%) patients at the time of initial admission. The overall mortality rate was 3.3%, increasing up to 45.0% among patients with severe AP. This study provides insights into the current status of AP in Korea, including its etiology, severity, and management. Results reveal disparities between clinical guidelines and their practical implementation for AP treatment.

• #66 Acute Pancreatitis – Diagnosis : Emergency Care BC

  https://emergencycarebc.ca/clinical_resource/clinical-summary/acute-pancreatitis-diagnosis/

  Acute pancreatitis (AP) commonly leads to hospital admission. 75% of cases are due to alcohol or gallstones/biliary tract disease in the developed world. Multiple other causes of pancreatitis include: Trauma, including ERCP; Metabolic abnormalities (e.g., hypercalcemia and hypertriglyceridemia); Viral infections (e.g., mumps, mononucleosis, hepatitis, coxsackie virus); Pregnancy; Lupus; Other conditions that block duct (e.g., tumour, congenital); Drugs, including antiretrovirals, chemotherapy, thiazide diuretics, sulfonamides, and azathioprine; Scorpion sting; Idiopathic. Pancreatic necrosis occurs in 5-10% of patients and may progress to infected necrosis which is associated with mortality rates of up to 30%. […] A diagnosis of AP is often made based on history, physical exam and serum lipase level. Imaging may be less urgent, occurring later in the work-up to determine the etiology. If no access to the necessary imaging modalities, patient transfer may be required.

• #67 Acute pancreatitis: current perspectives on diagnosis and management | JIR

  https://www.dovepress.com/acute-pancreatitis-current-perspectives-on-diagnosis-and-management-peer-reviewed-fulltext-article-JIR

  During an attack of acute pancreatitis, the elevation of alanine aminotransferase to 150 IU/L is a predictive factor for biliary cause of acute pancreatitis. A previous meta-analysis has indicated that this threefold elevation in alanine aminotransferase has a positive predictive value of 95% in diagnosing acute gallstone pancreatitis. […] The biochemical measurement of trypsinogen activation peptide (TAP) and trypsinogen-2 is more useful as a diagnostic marker for acute pancreatitis due to their accuracy, but their evaluation is limited by availability. […] Imaging plays an important role in the diagnosis and management of acute pancreatitis. As 50% of acute pancreatitis cases are gallstone-related, transabdominal ultrasound is the most common initial radiologic investigation of choice.

• #68 Current Diagnosis and Treatment of Acute Pancreatitis in Korea: A Nationwide Survey

  https://www.gutnliver.org/journal/view.html?uid=2184&vmd=Full

  The diagnosis of AP is based on abdominal pain, serum amylase and/or lipase levels 3-fold the upper normal limits, and radiographic findings consistent with AP. A diagnosis of AP is made when at least two of these three criteria are fulfilled. Acute biliary pancreatitis (ABP) was defined as gallstones or microliths in the common bile duct evident on transabdominal ultrasound, computed tomography, EUS, magnetic resonance cholangiopancreatography, or endoscopic retrograde cholangiography and fulfilment of the AP criteria. Hypertriglyceridemia-induced AP (HTG-AP) was defined as a serum triglyceride level 1,000 mg/dL at the time of admission. Acute alcoholic pancreatitis was diagnosed in cases of alcohol abuse or a chronic drinking history with no other identifiable cause of AP. […] In this study, the cause of AP during initial admission could not be found in 16.4% of patients. This is lower than the proportions in previous reports, possibly reflecting the use of more recent imaging techniques. EUS sensitively detects ABP, including microlithiasis, and magnetic resonance cholangiopancreatography is comparable to EUS. However, there is no definitive evidence or guidelines supporting the use of any particular imaging modality during the acute phase of AP.

• #69 The clinical characteristics of focal acute pancreatitis based on imaging diagnosis: comparison with non-localized acute pancreatitis- a preliminary result | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-023-03015-8

  Focal acute pancreatitis is a special type of acute pancreatitis, which diagnosis is based on image showing a focal mass formation in the pancreas. […] Our purpose was to find differences between focal acute pancreatitis and non-localized acute pancreatitis. […] We reviewed the medical records of a total of 24 patients diagnosed with focal acute pancreatitis by imaging and clinical diagnosis, and 27 cases of acute pancreatitis which manifest non-localized pancreas inflammation were selected as the control group. […] Compared with non-localized acute pancreatitis, changes in symptoms, signs and laboratory indicators of focal acute pancreatitis are non-obvious, however, there was no significant difference in the severity of two groups, indicating that we should pay more attention to diagnosis of focal acute pancreatitis in clinical practice.

• #70 The clinical characteristics of focal acute pancreatitis based on imaging diagnosis: comparison with non-localized acute pancreatitis- a preliminary result | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-023-03015-8

  For differences in etiology composition, clinical manifestations, laboratory tests between focal AP and non-localized AP, as far as we know, there are no relevant reports. […] The study found that changes in symptoms, signs and laboratory indicators of focal AP are not obvious, when compared with non-localized AP, however, there was no significant difference in the severity of the two groups. […] In this study, we found that there are statistically significant differences in neutrophil ratio, D-dimer, -glutamyltransferase (GGT), amylase, and lipase between the two groups. […] The peripheral blood neutrophil ratio in non-localized AP group was significantly higher than that in focal AP group, indicating that the inflammatory response of the former was more intense and more influential than that of the latter.

• #71 The clinical characteristics of focal acute pancreatitis based on imaging diagnosis: comparison with non-localized acute pancreatitis- a preliminary result | BMC Gastroenterology | Full Text

  https://bmcgastroenterol.biomedcentral.com/articles/10.1186/s12876-023-03015-8

  In focal acute pancreatitis, there were 17 and 22 patients met the criterion for serum amylase and lipase, in non-localized acute pancreatitis, that numbers were 17 and 23. […] We noticed that the laboratory changes of neutrophil ratio, D-dimer, GGT, amylase, and lipase were not so much evident in focal AP, compared with non-localized AP, which might result in missing diagnosis. […] Therefore, although focal AP is a limited inflammatory change in imaging, it does not show a milder disease than non-localized AP, on the contrary, focal AP is clinically more difficult to diagnose in a timely and accurate manner due to the insignificance of symptoms and changes in certain laboratory indicators, which requires the attention of clinicians.

• #72 Acute pancreatitis – Knowledge @ AMBOSS

  https://www.amboss.com/us/knowledge/acute-pancreatitis/

  CT abdomen is not routinely required to establish a diagnosis of acute pancreatitis. If performed to evaluate for necrotic pancreatitis, the optimal timing to perform a CT abdomen is at least 57 days after symptom onset. […] Suspect pancreatic tumor as the underlying cause for idiopathic acute pancreatitis in patients aged 40 years. […] Use adult diagnostic criteria for acute pancreatitis. […] Serum lipase is more reliable than amylase in infants. […] Abdominal ultrasound is the preferred initial imaging modality.

• #73 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  To predict the severity and mortality of AP, clinical data (including assessment of organ function) are assessed, laboratory tests and imaging are performed, and severity-of-the-disease rating systems are used. Those measures should be taken on admission and at 48 h. […] […] According to the recommendations, the diagnosis of acute pancreatitis is based on blood tests to determine the level of serum lipase and amylase and imaging techniques: magnetic resonance cholangiopancreatography (MRCP), CT, and US. Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP. Currently, no biochemical test has been identified that fulfills the above-mentioned criteria and can be considered the „gold standard” for the diagnosis and evaluation of the severity of AP. […]

• #74 Acute Pancreatitis Imaging: Practice Essentials, Radiography, Computed Tomography

  https://emedicine.medscape.com/article/371613-overview

  According to the revised Atlanta Classification, 2 out of 3 features are required for diagnosing acute pancreatitis: (1) acute-onset upper abdominal pain radiating to the back; (2) serum lipase or amylase levels 3 or more times higher than the normal range; and (3) classical imaging findings consistent with acute pancreatitis. […] Contrast-enhanced computed tomography (CECT) is the standard imaging modality for the evaluation of acute pancreatitis and its complications. […] The usefulness of CECT is limited in patients who are allergic to intravenous (IV) contrast or have renal insufficiency. […] Other adjunctive imaging modalities include ultrasonography (US), MRI, and angiography. […] In the emergency departments, the imaging modalities of choice are CT and ultrasound because of access, speed, and cost.

• #75 Diagnosis and Treatment of Acute Pancreatitis

  https://www.mdpi.com/2075-4418/12/8/1974

  To predict the severity and mortality of AP, clinical data (including assessment of organ function) are assessed, laboratory tests and imaging are performed, and severity-of-the-disease rating systems are used. Those measures should be taken on admission and at 48 h. […] […] According to the recommendations, the diagnosis of acute pancreatitis is based on blood tests to determine the level of serum lipase and amylase and imaging techniques: magnetic resonance cholangiopancreatography (MRCP), CT, and US. Measurements of serum and urinary enzymes are used to diagnose the AP, none of them allow the evaluation of the severity of the AP and the accurate prediction of the clinical course of the disease. […] […] The accurate diagnosis of AP, the early assessment of the severity of AP, and the identification of the etiology are criteria that should be met by an ideal laboratory test in assessing the condition of a patient with AP. Currently, no biochemical test has been identified that fulfills the above-mentioned criteria and can be considered the „gold standard” for the diagnosis and evaluation of the severity of AP. […]

Zobacz więcej