Advertisement

Diagnosis: What Historical Features and Laboratory Test(s) Are the Most Helpful to Make the Diagnosis? Is There Really a Normal Lipase with Active Pancreatitis? What “Red Flags” Suggest a Complicated Course?

  • Travis A. Thompson
Chapter

Abstract

Acute pancreatitis is defined as abdominal pain in the epigastric area with elevated pancreatic enzymes or signs of pancreatitis on advanced imaging. Two out of three characteristics are required to make the diagnosis. Both pancreatic enzymes amylase and lipase may be elevated, but lipase is more specific and can be used alone to make the diagnosis. Most cases of pancreatitis are mild and require only supportive care; however, signs of dehydration, infection, and persistent inflammation may indicate a more complicated course. It is difficult to determine learnersdictionary.com in the emergency department which patients will have a more severe course.

Keywords

Acute pancreatitis Lipase Amylase Computed tomography Risk factors Severe pancreatitis 

References

  1. 1.
    Baillie J. Clinical pancreatology for practicing gastroenterologists and surgeons. Gastroenterology. 2005;129(4):1356.CrossRefGoogle Scholar
  2. 2.
    Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology. American College of Gastroenterology guideline: management of acute pancreatitis. Am J Gastroenterol. 2013;108(9):1400–16.CrossRefGoogle Scholar
  3. 3.
    Yadav D, Lowenfels AB. Trends in the epidemiology of the first attack of acute pancreatitis: a systematic review. Pancreas. 2006;33(4):323–30.CrossRefGoogle Scholar
  4. 4.
    Coté GA, Yadav D, Slivka A, Hawes RH, Anderson MA, Burton FR, et al. Alcohol and smoking as risk factors in an epidemiology study of patients with chronic pancreatitis. Clin Gastroenterol Hepatol. 2011;9(3):266–73.CrossRefGoogle Scholar
  5. 5.
    Apte MV, Pirola RC, Wilson JS. Mechanisms of alcoholic pancreatitis. J Gastroenterol Hepatol. 2010;25(12):1816–26.CrossRefGoogle Scholar
  6. 6.
    Yadav D, Lowenfels AB. The epidemiology of pancreatitis and pancreatic cancer. Gastroenterology. 2013;144(6):1252–61.CrossRefGoogle Scholar
  7. 7.
    Forsmark CE, Vege SS, Wilcox CM. Acute pancreatitis. N Engl J Med. 2016;375(20):1972–81.CrossRefGoogle Scholar
  8. 8.
    Kwon RS, Banks PA. How should acute pancreatitis be diagnosed in clinical practice? In:Clinical pancreatology: Blackwell Publishing Ltd; Malden, Mass. 2004. p. 34–9.Google Scholar
  9. 9.
    Yadav D, Ng B, Saul M, Kennard ED. Relationship of serum pancreatic enzyme testing trends with the diagnosis of acute pancreatitis. Pancreas. 2011;40(3):383–9.CrossRefGoogle Scholar
  10. 10.
    Banks PA, Freeman ML. The practice parameters Committee of the American College of gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.CrossRefGoogle Scholar
  11. 11.
    Steinberg W, De Vries H, Wadden TA, Jensen CB, Svendsen CB, Rosenstock J. Tu1502 longitudinal monitoring of lipase and amylase in adults with type 2 diabetes and obesity: evidence from two phase 3 randomized clinical trials with the once-daily GLP-1 analog liraglutide. Gastroenterology. 2012;142(5):S850–1.CrossRefGoogle Scholar
  12. 12.
    O’Connor OJ, McWilliams S, Maher MM. Imaging of acute pancreatitis. Am J Roentgenol. 2011;197(2):W221–5.CrossRefGoogle Scholar
  13. 13.
    Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13(4 Suppl 2):e1–15.Google Scholar
  14. 14.
    Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.CrossRefGoogle Scholar
  15. 15.
    Baker M, Nelson R, Rosen M, Blake M, Cash B, Hindman N, et al. Acute pancreatitis. ACR appropriateness criteria – acute pancreatitis. 2013. Retrieved 24 Feb 2018 from https://acsearch.acr.org/docs.
  16. 16.
    Lankisch PG, Mahlke R, Blum T, Bruns A, Bruns D, Maisonneuve P, et al. Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol. 2001;96(7):2081–5.CrossRefGoogle Scholar
  17. 17.
    Wu BU, Johannes RS, Sun X, Conwell DL, Banks PA. Early changes in blood urea nitrogen predict mortality in acute pancreatitis. Gastroenterology. 2009;137(1):129–35.CrossRefGoogle Scholar
  18. 18.
    Mofidi R, Duff MD, Wigmore SJ, Madhavan KK, Garden OJ, Parks RW. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93(6):738–44.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Travis A. Thompson
    • 1
  1. 1.MedStar Washington Hospital Center, Department of Emergency MedicineWashington, DCUSA

Personalised recommendations