Acute Pancreatitis

Diagnostic Criteria

• Serum lipase remains elevated longer (8-14 days) compared to amylase (3-7 days) in patients with acute pancreatitis, and rises within 4-8 hours, peaking at 24 hours, with a diagnostic threshold of ≥3 times the upper limit of normal for lipase, as recommended by the American College of Emergency Physicians and the American Gastroenterological Association 1, 2
• A diagnostic threshold of ≥3 times the upper limit of normal for lipase or amylase is established for acute pancreatitis when accompanied by compatible clinical symptoms, with lipase having higher specificity 3, 2
• The American College of Emergency Physicians and the American Gastroenterological Association recommend measuring serum lipase (preferred) or amylase in patients with suspected acute pancreatitis, with levels ≥3 times upper limit of normal + compatible clinical symptoms being diagnostic of acute pancreatitis 1, 2

Laboratory Tests

• Triglyceride levels >1000 mg/dL suggests hypertriglyceridemic pancreatitis, and abnormal calcium levels can cause pancreatitis, according to the World Journal of Emergency Surgery 1
• Liver function tests (e.g. bilirubin, AST, ALT, alkaline phosphatase) and C-reactive protein ≥150 mg/L at 48-72 hours can indicate severe acute pancreatitis, as stated by the World Journal of Emergency Surgery and Gastroenterology 1, 2

Risk Factors and Predictors

• Hematocrit >44% is an independent risk factor for pancreatic necrosis, and elevated blood urea nitrogen is a predictor of mortality in patients with acute pancreatitis, according to the World Journal of Emergency Surgery 1
• Procalcitonin is sensitive for detecting pancreatic infection in patients with acute pancreatitis, and low values strongly predict absence of infected necrosis, as stated by the World Journal of Emergency Surgery and Gastroenterology 1, 4

Imaging and Additional Tests

• Contrast-enhanced CT scan can be considered if diagnosis remains uncertain, but early CT (within 72 hours) may underestimate pancreatic necrosis, as stated by Gastroenterology and Gut 2, 5
• Abdominal ultrasound to assess for gallstones should be checked if no obvious gallstones or alcohol history, as recommended by the World Journal of Emergency Surgery and Gastroenterology 1, 2, 5

Test Characteristics