From the Guidelines
Diagnosing pancreatitis requires a combination of clinical assessment, laboratory tests, and imaging studies, with serum amylase and/or lipase levels at least three times the upper limit of normal being a key diagnostic criterion. The diagnosis is typically established when a patient presents with characteristic abdominal pain (usually epigastric, radiating to the back) along with elevated pancreatic enzymes [ 1 ]. Additional diagnostic tools include contrast-enhanced CT scans, which can identify pancreatic inflammation, necrosis, or complications, and are particularly useful in severe cases [ 1 ].
Key Diagnostic Criteria
- Serum amylase and/or lipase levels at least three times the upper limit of normal
- Characteristic abdominal pain (usually epigastric, radiating to the back)
- Elevated C-reactive protein level ≥ 150 mg/l at third day can be used as a prognostic factor for severe acute pancreatitis [ 1 ]
- Hematocrit > 44% represents an independent risk factor of pancreatic necrosis [ 1 ]
Additional Diagnostic Tools
- Contrast-enhanced CT scans to identify pancreatic inflammation, necrosis, or complications
- Ultrasound to identify gallstones, a common cause of acute pancreatitis
- Magnetic resonance cholangiopancreatography (MRCP) to evaluate the pancreatic and biliary ducts for abnormalities
- Endoscopic ultrasound to identify microlithiasis, early chronic pancreatitis, or pancreatic tumors in patients with recurrent pancreatitis of unclear etiology
Laboratory Tests
- Complete blood count
- Metabolic panel
- Liver function tests
- Triglycerides and calcium levels to identify potential causes and assess severity [ 1 ]
From the Research
Diagnosis of Pancreatitis
- The diagnosis of acute pancreatitis requires the presence of at least two of the three diagnostic criteria: characteristic abdominal pain, elevated serum amylase or lipase, and radiological evidence of pancreatitis 2, 3, 4, 5.
- Serum concentrations of amylase and lipase rise within hours of the pancreatic injury, with a threshold concentration 2-4 times the upper limit of normal recommended for diagnosis 5.
- Serum lipase is now the preferred test due to its improved sensitivity, particularly in alcohol-induced pancreatitis, and its prolonged elevation creates a wider diagnostic window than amylase 2, 6, 5.
Laboratory Tests
- Serum amylase and lipase remain important tests in the diagnosis of acute pancreatitis, but neither enzyme is useful in monitoring or predicting the severity of an episode of pancreatitis in adults 6, 5.
- New biomarkers including trypsinogen and elastase have no significant advantage over amylase or lipase 5.
- Other laboratory tests such as serum C-reactive protein, serum interleukins 6 and 8, and urinary trypsinogen activation peptides may be useful in predicting the severity of acute pancreatitis 6.
Imaging Studies
- Radiological evidence of pancreatitis, such as findings on computed tomography (CT) scan or magnetic resonance imaging (MRI), is one of the diagnostic criteria for acute pancreatitis 3, 4.
- Abdominal cross-sectional imaging may be undertaken to detect complications, such as if C-reactive protein exceeds 150 mg/L, or to investigate rarer aetiologies 4.
Diagnostic Accuracy
- Serum lipase offers a higher sensitivity than serum amylase in diagnosing acute pancreatitis, and its larger diagnostic window makes it a useful diagnostic biomarker in early and late stages of acute pancreatitis 2.
- The co-ordering of both amylase and lipase tests has shown little to no increase in diagnostic sensitivity and specificity, and unnecessary testing and laboratory expenditures can be reduced by testing lipase alone 2.