Acute Pancreatitis

 

 

To make a diagnosis of acute pancreatitis (from any cause), one needs 2 out of 3 of the following criteria: 

Clinical symptoms:

Persistent, severe, epigastric pain with tenderness on palpation

Laboratory studies:

Serum amylase or lipase greater than 3 times the upper limit of normal;  

Lipase remains elevated for a longer period of time and has a higher specificity as compared with amylase

Imaging:

Computed Tomography, Magnetic Resonance (MR), Ultrasonography)

Showing Focal or Diffuse Enlargement of Pancreas

 

In a patient with a characteristic clinical presentation, the demonstration of an elevated serum amylase or lipase level will confirm the diagnosis of acute pancreatitis. However, serum amylase may be spuriously normal in patients with hypertriglyceridemia and spuriously elevated in patients with acidemia (arterial pH ≤ 7.32), serum lipase is the preferred laboratory test for diagnosing acute pancreatitis. It is important to note, however, that there is no correlation between the severity of pancreatitis and the degree of serum lipase and amylase elevations. Additionally, an elevation in serum triglyceride levels is not sufficient to diagnose acute pancreatitis. Hyperbilirubinemia, leukocytosis, azotemia, and hypoglycemia are suggestive of more severe disease, but are not themselves diagnostic of acute pancreatitis.

Major takeaway

Acute pancreatitis is characterized by epigastric abdominal pain radiating to the back, often with nausea and vomiting. The diagnosis is made by meeting 2 of the 3 clinical, laboratory, and imaging criteria. The preferred diagnostic laboratory test for acute pancreatitis is a serum lipase greater than 3 times the upper limit of normal. 

ü   Patient presenting with constant abdominal pain localized in the epigastric region that radiates to the back, highly suggestive of acute pancreatitis. Acute pancreatitis occurs when pancreatic enzymes are inappropriately activated, leading to tissue damage and an inflammatory response. This patient has a family history of recurrent pancreatitis in his father and paternal uncle, suggesting the diagnosis of familial hypertriglyceridemia, an autosomal dominant condition.

ü  The high concentration of serum triglycerides can cause acute pancreatitis because when pancreatic cells encounter triglycerides, they release lipase to break the triglycerides down into free fatty acids; excess free fatty acids can subsequently injure the pancreas. 

ü  Although serum amylase elevation may be used to show biochemical evidence of acute pancreatitis, it is affected by serum pH, lipids, and bowel inflammation, and is prone to false elevations or spuriously normal results. Therefore, it is not the most specific in diagnosing this patient’s acute pancreatitis.