Pancreatitis, Acute - Acute Pancreatitis

  • Diagnosis
  • Background
  • Lab Tests
  • References
  • Related Content

Indications for Testing

  • Abdominal pain in epigastrium

Laboratory Testing

  • Lipase
    • ≥3 times normal level is diagnostic
    • More sensitive and specific for pancreatic disease than amylase
    • Amylase less sensitive – doesn’t necessarily need to be ordered
    • Serial measures not necessary as they do not provide prognostication
  • CBC – leukocytosis common in severe disease
  • Metabolic panel (sodium, potassium, BUN, creatinine, calcium, glucose, HCO3)
    • Calcium, BUN and glucose aberrations may be associated with prognosis
  • C-reactive protein – concentration ≥150 mg/dL within the first 72 hours after presentation suggests acute necrotizing pancreatitis
    • Order 48 hours after illness onset to prevent false negatives
  • Procalcitonin – may have value in differentiating between mild and severe disease
    • Should be obtained at admission

Imaging Studies

  • US/CT/ERCP – all used to confirm diagnosis or to assess local complications such as fluid collections and neurosis

Prognosis

  • Prognostic criteria

Differential Diagnosis

  • Acute cholecystitis
  • Acute coronary syndromes
  • Aortic dissection
  • Appendicitis
  • Cholangitis
  • Diabetic ketoacidosis
  • Ectopic pregnancy
  • Gastric outlet obstruction
  • Gastric volvulus
  • Intestinal obstructions
  • Mesenteric ischemia
  • Nephrolithiasis
  • Pancreatic cancer
  • Perforated duodenal/gastric ulcer
  • Tubo-ovarian abscess

Acute pancreatitis is a reversible inflammatory process of the pancreas that may be associated with a systemic inflammatory response that can cause multiorgan impairment.

Epidemiology

  • Incidence – 30-40/100,000 in the U.S.
  • Age – peaks in 40s
  • Sex
    • Gallstone-induced pancreatitis, M<F
    • Alcohol-induced pancreatitis, M>F

Risk Factors

Pathophysiology

  • Inappropriate or premature activation of trypsinogen thought to be the initiating event
  • Early stages are characterized by interstitial edema of pancreatic parenchyma and necrosis of peripancreatic fat
  • In 20% of patients, pancreatitis progresses to coagulation necrosis of glandular elements

Clinical Presentation

Indications for Laboratory Testing

Tests generally appear in the order most useful for common clinical situations.
Click on number for test-specific information in the ARUP Laboratory Test Directory

Amylase, Serum or Plasma 0020013
Method: Quantitative Enzymatic

Limitations

False positives occur in macroamylasemia, renal failure, esophageal perforation, pregnancy and mumps parotitis

Lipase, Serum or Plasma 0020014
Method: Quantitative Enzymatic

Limitations

False positives occur in renal failure, intestinal perforation

CBC with Platelet Count and Automated Differential 0040003
Method: Automated Cell Count/Differential

Comprehensive Metabolic Panel 0020408
Method: Quantitative Ion-Selective Electrode/Quantitative Enzymatic/Quantitative Spectrophotometry

Procalcitonin 0020763
Method: Immunofluorescence

Limitations

Procalcitonin levels measured shortly after the systemic infection process begins (usually <6 hours) may still be low because other noninfectious conditions also induce procalcitonin

Review procalcitonin levels of 0.50–2.00 ng/mL in light of patient’s specific clinical background and individual condition

C-Reactive Protein 0050180
Method: Quantitative Immunoturbidimetry

Limitations

Obtain ≥48 hours after illness begins to help prevent false negatives

Trypsin-Like Immunoreactivity 0070003
Method: Quantitative Radioimmunoassay

Additional Tests Available

Urea Nitrogen, Serum or Plasma 0020023
Method: Quantitative Spectrophotometry

Comments

Screening test to evaluate kidney function

Prognostic score in Ranson criteria

Bilirubin, Direct and Total, Serum or Plasma 0020426
Method: Quantitative Spectrophotometry

Comments

Diagnose biliary etiology for acute pancreatitis

Bilirubin, Direct, Serum or Plasma 0020033
Method: Quantitative Spectrophotometry

Comments

Bilirubin component test

Bilirubin, Total, Serum or Plasma 0020032
Method: Spectrophotometry

Comments

Bilirubin component test

Amylase, Urine 0020471
Method: Quantitative Enzymatic

Comments

Rule out macroamylasemia as cause of elevated amylase

Amylase, Body Fluid 0020506
Method: Quantitative Enzymatic

Comments

Not useful in diagnosis of disease; however, may help identify pancreatitis as a cause

Lipase, Fluid 0020715
Method: Quantitative Enzymatic

Comments

Not useful in diagnosis of disease; however, may help identify pancreatitis as a cause

For information on body fluid reference ranges and/or interpretive guidance visit http://aruplab.com/bodyfluids/

Amylase, Isoenzymes 0020804
Method: Quantitative Enzymatic

Comments

Rule out salivary amylase as cause of elevated amylase

Macroamylase Determination 2004464
Method: Quantitative Ultrafiltration/Quantitative Enzymatic

Guidelines

Pezzilli R, Zerbi A, Di Carlo V, Bassi C, Fave G, Working Group of the Italian Association for the Study of the Pancreas on Acute Pancreatitis. Practical guidelines for acute pancreatitis. Pancreatology. 2010; 10(5): 523-35. PubMed

General References

AlMofleh I. Severe acute pancreatitis: pathogenetic aspects and prognostic factors. World J Gastroenterol. 2008; 14(5): 675-84. PubMed

Baron T. Managing severe acute pancreatitis. Cleve Clin J Med. 2013; 80(6): 354-9. PubMed

Bollen T, van Santvoort H, Besselink M, van Leeuwen M, Horvath K, Freeny P, Gooszen H, Dutch Acute Pancreatitis Study Group. The Atlanta Classification of acute pancreatitis revisited. Br J Surg. 2008; 95(1): 6-21. PubMed

Carroll J, Herrick B, Gipson T, Lee S. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician. 2007; 75(10): 1513-20. PubMed

Frossard J, Steer M, Pastor C. Acute pancreatitis. Lancet. 2008; 371(9607): 143-52. PubMed

Gupta K, Wu B. In the clinic. Acute pancreatitis. Ann Intern Med. 2010; 153(9): ITC51-5; quiz ITC516. PubMed

Harper S, Cheslyn-Curtis S. Acute pancreatitis. Ann Clin Biochem. 2011; 48(Pt 1): 23-37. PubMed

Johnson C, Besselink M, Carter R. Acute pancreatitis. BMJ. 2014; 349: g4859. PubMed

Mofidi R, Patil P, Suttie S, Parks R. Risk assessment in acute pancreatitis. Br J Surg. 2009; 96(2): 137-50. PubMed

Quinlan J. Acute pancreatitis. Am Fam Physician. 2014; 90(9): 632-9. PubMed

Stevens T, Parsi M, Walsh M. Acute pancreatitis: problems in adherence to guidelines. Cleve Clin J Med. 2009; 76(12): 697-704. PubMed

Medical Reviewers

Last Update: December 2015