Clinical Characteristics
The majority of patients with acute pancreatitis have severe abdominal pain of sudden onset in the upper part.
Patients may also experience nausea and vomiting. On physical examination, patients exhibit abdominal tenderness. Patients with severe acute pancreatitis may present with fever, tachypnea, tachycardia, hypoxemia, and hypotension.
Laboratory Tests
At the onset of acute pancreatitis, pancreatic enzymes leak from acinar cells into the interstitial space and then into the systemic circulation.
Affected patients may therefore present with an acute elevation of serum amylase and lipase. As well as other pancreatic enzymes, degradation products, and inflammatory mediators.
Serum lipase has a slightly higher sensitivity for acute pancreatitis. Increases appear earlier and persist longer compared to amylase.
It is particularly useful for patients who consult the clinician late. Serum lipase is also more sensitive than amylase in patients with alcohol-related pancreatitis.
Abdominal CT Scan Results
About 85% of patients with acute pancreatitis have edematous interstitial acute pancreatitis, characterized by pancreatic enlargement visible on a contrast-enhanced abdominal CT scan. This form manifests as swelling of the pancreas, which is observable on medical imaging.
About 15% of patients suffer from necrotizing pancreatitis, which is marked by necrosis of the pancreatic parenchyma, peripancreatic tissues, or both. This form of pancreatitis leads to tissue death, which can affect the pancreas and surrounding tissues.
Diagnosis of Pancreatitis
The diagnosis is defined by the presence of two of the following criteria:
- Characteristic findings of acute pancreatitis on imaging tests, such as contrast-enhanced CT scan, MRI, or transabdominal ultrasound.
- Sudden onset of persistent and severe epigastric pain, often radiating to the back.
- Elevation of serum lipase or amylase levels to three times or more the upper limit of normal.
In patients with characteristic abdominal pain and elevation of serum lipase or amylase levels to three times or more the upper limit of normal, no imaging test is necessary to establish the diagnosis.
In patients whose abdominal pain is not typical of acute pancreatitis or whose serum amylase and/or lipase activity is less than three times the upper limit of normal, we perform a contrast-enhanced abdominal CT scan to confirm the diagnosis and to rule out other causes of acute abdominal pain.
Source: UpToDate