By Dr Ananya Mandal, MD
Acute pancreatitis is a medical emergency and needs to be diagnosed immediately upon admission with severe abdominal pain.
Significant history of risk factors like obesity, alcohol use, gall bladder stones are obtained and acute pancreatitis is suspected. The abdomen feels tender or painful to touch.
Tests for acute pancreatitis
Several diagnostic, laboratory and imaging studies are prescribed. These include:-
The pancreas during its inflamed state produces high levels of two chemicals called amylase and lipase. Testing the levels of these two chemicals can help detect pancreatitis.
Other blood tests prescribed within the first 24 hours of onset of symptoms include assessment of liver biochemistry, calcium levels and blood triglycerides.
Initially the first imaging study performed is an abdominal ultrasound scan. This can help detect presence of gall bladder stones.
A computerized tomography (CT scan) can show the picture of the damaged pancreas in details.
During early stages of acute pancreatitis symptoms alone cannot determine the severity of the inflammation. An X ray or CT scan helps in detecting the extent of inflammation.
The role of magnetic resonance imaging (MRI) in the diagnosis of acute pancreatitis and establishment of severity is not yet established.
An endoscopic retrograde cholangiopancreatography (ERCP) ERCP involves the use of a narrow, flexible tube, known as an endoscope. The endoscope has a camera on one end. It will be guided into the intestines using an ultrasound as guidance. ERCP detects gall bladder, bile duct and pancreas pathologies.
Characteristic symptoms of acute pancreatitis
Characteristic symptoms that are often diagnostic of acute pancreatitis include two of the three features including:-
1 - Characteristic pain in the abdomen
2 - Rise of serum amylase or lipase levels of over three times the upper limit of normal value. Generally both amylase and lipase are elevated during the course of acute pancreatitis. The serum lipase may remain elevated slightly longer than amylase.
This said, the extent of rise or peak levels of amylase and lipase are not directly associated with the severity of acute pancreatitis. Serum lipase may remain normal in some nonpancreatic pathologies whereas serum amylase may be raised in several non-pancreatic pathologies. This includes macroamylasemia, parotitis, and some cancers.
Although routine and daily monitoring of these enzymes is of little value in determining the gradual recovery, it has been seen that is serum amylase and/or lipase remain elevated for several weeks, there may be persisting pancreatic inﬂammation, blockage of the pancreatic duct or presence of a pseudocyst.
3 - Specific findings related to pancreatic inflammation on CT scan. A CT scan along with special contrast dyes can clearly delineate areas of the pancreas that have been damaged by the inflammation.
Contrast CT scan also helps in diagnosing the cause of pancreatic inflammation including presence of common bile duct stones, pancreatic calciﬁcations, chronic pancreatitis caused by excessive alcohol consumption or pancreas cancers.
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)