From the Guidelines
Acute pancreatitis is defined as a disease characterized by acute inflammation of the pancreas and histologically acinar cell destruction, requiring at least two of the three following criteria: abdominal pain consistent with the disease, biochemical evidence of pancreatitis, and characteristic findings from abdominal imaging. The diagnosis of acute pancreatitis is crucial, as it can lead to severe complications and high mortality rates if left untreated or misdiagnosed 1. According to the 2019 WSES guidelines for the management of severe acute pancreatitis, the diagnosis of acute pancreatitis requires a combination of clinical, biochemical, and imaging findings 1.
The clinical presentation of acute pancreatitis typically includes severe upper abdominal pain that may radiate to the back, nausea, vomiting, fever, and elevated heart rate. The two most common causes of acute pancreatitis are gallstones and excessive alcohol consumption, though other causes include certain medications, high triglyceride levels, infections, and trauma. Biochemical evidence of pancreatitis includes elevated serum amylase and/or lipase levels greater than three times the upper limit of normal. Imaging studies such as CT scans or ultrasound can also help confirm the diagnosis by showing characteristic findings of pancreatic inflammation and necrosis.
It is essential to note that the diagnosis of acute pancreatitis should be made within 48 hours of admission, and other life-threatening conditions should be excluded 1. The correct diagnosis and timely treatment of acute pancreatitis can significantly improve patient outcomes and reduce morbidity and mortality.
Key points to consider in the diagnosis of acute pancreatitis include:
- Abdominal pain consistent with the disease
- Biochemical evidence of pancreatitis (elevated serum amylase and/or lipase levels)
- Characteristic findings from abdominal imaging (CT scans or ultrasound)
- Exclusion of other life-threatening conditions
- Timely diagnosis and treatment to improve patient outcomes.
From the Research
Definition of Acute Pancreatitis
- Acute pancreatitis (AP) is defined as the acute nonbacterial inflammatory condition of the pancreas, derived from the early activation of digestive enzymes found inside the acinar cells, with variable compromise of the gland itself, nearby tissues, and other organs 2.
- It is an event that begins with pancreatic injury, elicits an acute inflammatory response, encompasses a variety of complications, and generally resolves over time 2.
- Acute pancreatitis is an inflammatory condition of the exocrine pancreas that is a common indication for hospital admission and has had an increasing incidence in the last few decades 3.
- It is a disease with extremely different clinical expressions, with most patients suffering a mild and limited disease, but about one-fifth of cases develop multi-organ failure, accompanied by high mortality 2.
Diagnostic Criteria
- 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 4.
- The diagnosis requires two of upper abdominal pain, amylase/lipase ≥ 3 × upper limit of normal, and/or cross-sectional imaging findings 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 4.
Pathogenesis and Clinical Management
- Acute pancreatitis is a complex condition involving the activation of digestive enzymes, inflammation, and potentially, systemic complications 2, 6.
- The clinical management is mainly based on the disease's severity and must be directed to correct the underlying predisposing factors and control the inflammatory process itself 2.
- Initial priorities in treatment include intravenous fluid resuscitation, analgesia, and enteral nutrition, with critical care and organ support, parenteral nutrition, antibiotics, and pancreatic exocrine and endocrine replacement therapy as needed 5.