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Diagnostic standards for acute pancreatitis

  • World Progress in Surgery-Acute Pancreatitis:Diagnosis and Treatment
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Abstract

An accurate history and thorough physical examination will often raise clinical suspicion of acute pancreatitis in the differential diagnosis of a patient presenting with acute abdominal pain. An accurate diagnosis is needed to eliminate etiologies of acute abdominal pain and to appropriately direct therapy. Confirmation of the diagnosis is most often made by evaluation of serum amylase and lipase levels. Although hyperamylasemia is found in the majority of patients with acute pancreatitis, other nonpancreatic acute abdominal conditions may be present with hyperamylasemia. CT scanning provides an accurate confirmation of clinical and laboratory findings and offers excellent anatomic and morphologic representation of the pancreas and peripancreatic tissue. The following article, written by the late John H.C. Ranson, presents a discussion of the modalities available for diagnosing acute pancreatitis.

Résumé

La pancréatitc aiguë est une maladie relativement fréquente dont l’incidence est en hausse. Son diagnostic est difficile. Dans une étude présentée par Bockus à partir de 94 admissions pour pancréatite aiguë, le diagnostic était inexact chez 43 % des cas. La pancréatite a été prise le plus souvent pour une cholécystitc aiguë (20%), une perforation de viscère creux (7%) ou une occlusion intestinale (5%). Chez le patient ayant une pancréatite aiguë fatale, le diagnostic correct n’a pas été fait avant l’autopsie dans 41.6% des cas. Il n’existe aucun critère clinique ou biologique qui permette le diagnostic certain de pancréatite aiguë à tous les coups. Les données opératoires ou autopsiques ne sont disponibles que chez un faible pourcentage des patients. Les données de la tomodensitométrie sont parfois diagnostiques, mais cet examen peut être normal chez le patient ayant une forme mineure de la maladie. Les critères diagnostiques de la pancréatite aiguë sont passés en revue. Il faut souligner que le diagnostic initial dépend principalement d’un interrogatoire précis ainsi que d’un examen physique soigneux.

Resumen

La pancreatitis aguda es una entidad común, con frecuencia de dificil diagnóstico, cuya incidencia es creciente. En un estudio realizado por Bockus en 94 pacientes hospitalizados por pancreatitis aguda, el diagnósti co inicial resultó incorrecto en 43% de los casos. Comúnmente se confundio la pancreatitis aguda con colecistitis aguda (20%), víscera perforada (7%) u obstructión intestinal (5%). En los casos de pancreatitis aguda letal, el diagnóstico correcto solo es establecido en el momento de la autopsia, lo cual ocurre en 41.6% de los casos. Desafortunadamente no existen criterios clínicos o de laboratorio que permitan un diagnóstico certero de pancreatitis aguda en la totalidad de los pacientes. Los hallazgos operatorios o de necropsia están disponibles sólo en una pequena minoría de los casos. Los hallazgos radiológicos en tomografia computadorizada pueden ser diagnósticos de la entidad, pero el estudio puede aparecer normal en los pacientes con enfermedad leve. Es por ello que en el presente artìculo se revisan las características diagnósticas. Debe hacerse énfasis en que el diagnóstico inicial depende, primordialmente, de una bien orientada historia clìnica y de un meticuloso examen fisico.

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Authors and Affiliations

  1. Department of Surgery, New York University School of Medicine, 10016, New York, New York, USA

    John H. C. Ranson

  2. Department of Surgery, New York University Medical Center, 530 First Avenue, Suite 6B, 10016, New York, NY, USA

    Peter Shamamian

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Ranson, J.H.C., Shamamian, P. Diagnostic standards for acute pancreatitis. World J. Surg. 21, 136–142 (1997). https://doi.org/10.1007/s002689900205

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