Diagnosing Pancreatitis and Cholestasis

Initial Evaluation

For suspected pancreatitis, serum amylase or lipase levels should be obtained, which are elevated in acute pancreatitis, according to the American Gastroenterological Association 1
Liver function tests, including bilirubin, AST, and ALT, should be performed to evaluate liver function, as recommended by the American Gastroenterological Association 1
Triglyceride and calcium levels should be evaluated to assess potential causes of pancreatitis, as suggested by the American Gastroenterological Association 1
Serum antimitochondrial antibodies (AMA) should be tested for suspected primary biliary cholangitis (PBC), as recommended by the European Association for the Study of the Liver 2, 3

Contrast-enhanced CT scan should be performed after 72 hours of illness onset in patients with predicted severe pancreatitis or evidence of organ failure, according to the American Gastroenterological Association 1
Ultrasound is the first-line non-invasive imaging procedure to differentiate intrahepatic from extrahepatic cholestasis, as recommended by the European Association for the Study of the Liver 2, 3
Magnetic resonance cholangiopancreatography (MRCP) has 96-100% sensitivity for detecting bile duct stones and is preferred over diagnostic ERCP due to lower complication risk, as stated by the European Association for the Study of the Liver 2, 3

The diagnostic algorithm for cholestasis should start with abdominal ultrasound to distinguish between intrahepatic and extrahepatic cholestasis, as recommended by the European Association for the Study of the Liver 2, 3
If extrahepatic obstruction is suspected, MRCP or endoscopic ultrasound (EUS) should be performed, and ERCP should be reserved for therapeutic interventions, as suggested by the European Association for the Study of the Liver 2, 3
The diagnostic algorithm for pancreatitis should start with measuring serum amylase or lipase levels, and determining etiology through detailed history and abdominal ultrasound, as recommended by the American Gastroenterological Association 1

In patients >40 years with unexplained pancreatitis, CT or EUS should be performed to rule out pancreatic malignancy, as recommended by the American Gastroenterological Association 1
In patients with recurrent unexplained pancreatitis, evaluation with EUS and/or ERCP should be considered, as suggested by the American Gastroenterological Association 1

Diagnostic ERCP should not be performed as first-line investigation due to its significant complication rate; use MRCP or EUS instead, as recommended by the European Association for the Study of the Liver 3
Imaging should not be delayed in patients with predicted severe pancreatitis, as early detection of complications is crucial, according to the American Gastroenterological Association 1