Acute pancreatitis diagnostic criteria

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]

Overview

According to the American college of Gastroenterology, the diagnosis of AP is most often established by the presence of two of the three following criteria: abdominal pain consistent with the disease, serum amylase and/or lipase greater than three times the upper limit of normal, and/or characteristic findings from abdominal imaging. Contrast-enhanced computed tomographic (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically within the first 48-72h after hospital admission. Ranson criteria may be used to predict the severity of acute pancreatitis. If the score >=3, severe pancreatitis is likely to be present.

Diagnosis

According to the American college of gastroenterology, following are the diagnostic guidelines for acute pancreatitis:[1]

Recommendation Evidence Level Strength of Recommendation
The diagnosis of AP is most often established by the presence of two of the three following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than three times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging. Moderate Strong
Contrast-enhanced computed tomographic (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically within the first 48-72h after hospital admission. Low Strong
Transabdominal ultrasound should be performed in all patients with acute pancreatitis Low Strong
In the absence of gallstones and/or history of significant history of alcohol use, a serum triglyceride should be obtained and considered the etiology if >1,000 mg/dl  Moderate Conditional
In a patient older than 40 years, a pancreatic tumor should be considered as a possible cause of acute pancreatitis Low Conditional
Endoscopic investigation in patients with acute idiopathic pancreatitis should be limited, as the risks and benefits of investigation in these patients are unclear Low Conditional
Patients with idiopathic pancreatitis should be referred to centers of expertise Low Conditional
Genetic testing may be considered in young patients (<30 years old) if no cause is evident and a family history of pancreatic disease is present Low Conditional

Ranson Risk Score Calculator

Ranson criteria for gallstone pancreatitis

At admission:

  1. Age in years > 70 years
  2. White blood cell count > 18000 cells/mm3
  3. Blood glucose > 12.2 mmol/L (> 220 mg/dL)
  4. Serum AST > 250 IU/L
  5. Serum LDH > 400 IU/L

At 48 hours:

  1. Hematocrit fall > 10%
  2. Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
  3. Oxygen (hypoxemia PO2 < 60 mmHg)
  4. BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
  5. Base deficit (negative base excess) > 5 mEq/L
  6. Sequestration of fluids > 4 L

References

  1. Malka D, Rosa-Hézode I (2001). "[Positive and etiological diagnosis of acute pancreatitis]". Gastroenterol. Clin. Biol. (in French). 25 (1 Suppl): 1S153–68. PMID 11223588.

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