Evaluation of Sonography in the Diagnosis of Acute Pancreatitis

Abstract

Diagnosis of acute pancreatitis is based on clinical symptoms, such as abdominal pain, and on confirmation of raised pancreatic enzymes in serum (α-amylase, lipase, trypsin) and/or in urine (α-amylase). A direct assessment of morphological pancreatic changes has only become possible since the introduction of morphological methods of examination such as ultrasonography and computed tomography, the therapeutic procedure has traditionally been determined by the doctor’s intuition, chemical changes, and the clinical course of the disease after conservative treatment. There is a great variety of classifications of the severity of illness, giving certain prognostic information regarding the expected course [1], as there is of advice regarding the best moment at which to operate in acute pancreatitis. It is still unclear whether a definite overall picture leading to standardized procedures of therapy, particularly concerning the right time for operation, can be achieved by examination of morphological changes in the pancreatic site, visualised by ultrasonography and computed tomography. On the contrary, anyone who has followed the discussions of experienced pancreatologists realizes with bewilderment that, first, the doctor’s evaluation of ultrasonography of the pancreas varies from “enormous diagnostic improvement” to “merely confusing“, and, opinions secondly, regarding indications for operation differ, with extreme points of view relating the decision for surgical intervention exclusively to the clinical course of the disease or exclusively to morphological changes (e.g. the spreading of necrosis in the pancreatic site).

Dedicated to Professor F.W. Schmidt, M.D., Head of the Department of Gastroenterology and Hepatology, Centre of Internal Medicine and Dermatology, Medical University of Hanover, for his 60th birthday.