Initial Laboratory and Imaging Studies for Suspected Pancreatitis and Hepatitis

Laboratory Tests for Pancreatitis

The American Gastroenterological Association recommends serum lipase as the preferred test over amylase due to its higher specificity and longer elevation in serum after onset of symptoms 1, 2
C-reactive protein is a useful indicator of severity when measured >48 hours after symptom onset, with values >150 mg/L suggesting severe pancreatitis 2, 4
The American Gastroenterological Association suggests complete blood count to assess for leukocytosis and hemoconcentration 2
Triglyceride levels should be measured to identify hypertriglyceridemia as a potential cause of pancreatitis 1

The American Association for the Study of Liver Diseases recommends ALT/AST to assess the degree of hepatocellular injury 6, 5
Alkaline phosphatase and GGT should be evaluated to assess for a cholestatic pattern 6, 7
Bilirubin (total and direct) should be measured to assess liver function and degree of jaundice 6, 7
The American Association for the Study of Liver Diseases suggests albumin and prothrombin time/INR to evaluate synthetic liver function 7

Abdominal ultrasound is the first-line imaging modality to detect gallstones, biliary dilation, and assess the pancreas, although pancreas visualization is limited in 25-50% of cases 1, 4, 9
Contrast-enhanced CT scan is indicated when diagnosis is uncertain or to assess severity and complications, ideally performed 72-96 hours after symptom onset 1, 4
MRI/MRCP is useful for evaluating biliary and pancreatic ducts, particularly when gallstone pancreatitis is suspected 1
Endoscopic ultrasound (EUS) can be used to detect microlithiasis, common bile duct stones, or pancreatic abnormalities when other imaging is inconclusive 1, 4

The American Gastroenterological Association recommends considering drug-induced injury as a potential cause for both pancreatitis and hepatitis 6, 5
Up to 25% of cases of acute pancreatitis may be idiopathic despite thorough evaluation, according to the American Gastroenterological Association 1, 4

For pancreatitis, repeat lipase/amylase to monitor trends, and C-reactive protein at 48 hours to assess severity, as recommended by the World Journal of Emergency Surgery 2, 4
For hepatitis, serial liver function tests should be performed to monitor progression, and viral load testing when appropriate, according to the American Association for the Study of Liver Diseases 8, 7