From the Guidelines
The diagnosis of acute pancreatitis requires at least two of three criteria: characteristic abdominal pain, elevated pancreatic enzymes, or supportive imaging findings, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The abdominal pain is typically severe, located in the epigastrium, and often radiates to the back.
- Serum lipase and amylase levels should be at least three times the upper limit of normal to be considered diagnostic, with lipase being more specific and reliable than amylase 1.
- Imaging findings on CT scan or MRI may show pancreatic inflammation, edema, or necrosis, and are important for confirming the diagnosis and assessing the severity of the disease 1. These criteria are important because no single symptom or test is sufficient for diagnosis. Once diagnosed, severity assessment should be performed using scoring systems like the Ranson criteria, APACHE II, or the modified Glasgow score. Laboratory tests should include complete blood count, metabolic panel, liver function tests, triglycerides, and calcium levels to identify potential causes and complications. Initial management includes fluid resuscitation, pain control with opioid analgesics, and bowel rest. Early identification is crucial as severe acute pancreatitis can lead to significant morbidity and mortality from complications like pancreatic necrosis, pseudocysts, or multi-organ failure. The 2019 WSES guidelines also recommend the use of the Determinant-Based Classification (DBC) and the Revised Atlanta Classification (RAC) for assessing the severity of acute pancreatitis 1. The DBC categorizes acute pancreatitis into four categories: mild, moderate, severe, and critical, based on the presence of organ failure and pancreatic necrosis. The RAC also categorizes acute pancreatitis into three categories: mild, moderately severe, and severe, based on the presence of organ failure and local complications. Both classifications have been shown to be effective in predicting outcomes and guiding management in patients with acute pancreatitis 1.
From the Research
Diagnostic Criteria for Acute Pancreatitis
The diagnosis of acute pancreatitis requires the satisfaction of two out of three criteria:
- Abdominal pain radiating to the back
- Serum lipase or amylase levels three or more times the upper limit of the normal level
- Findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI) 2
Laboratory Tests
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 3.
- Serum lipase is now the preferred test due to its improved sensitivity, particularly in alcohol-induced pancreatitis 3
- Serum lipase offers a higher sensitivity than serum amylase in diagnosing acute pancreatitis and has a larger diagnostic window 4
Imaging Studies
Imaging studies such as CT and MRI can be useful to assess severity or if the diagnosis is uncertain, but are not required to diagnose acute pancreatitis 5.