From the Guidelines
Pancreatitis is diagnosed based on the presence of at least two of three key criteria: characteristic abdominal pain, elevated pancreatic enzymes, and supportive imaging findings, as stated in the 2019 WSES guidelines for the management of severe acute pancreatitis 1. The abdominal pain typically presents as severe epigastric pain that may radiate to the back.
- Serum lipase and amylase levels should be at least three times the upper limit of normal to support the diagnosis, with lipase being more specific and preferred, as noted in the 2019 WSES guidelines 1 and the AGA institute medical position statement on acute pancreatitis 1.
- Imaging findings on CT scan, MRI, or ultrasound showing pancreatic inflammation, edema, or necrosis provide the third diagnostic criterion. Additional laboratory tests that may support the diagnosis include:
- Elevated inflammatory markers (CRP, WBC count)
- Abnormal liver function tests
- Elevated triglycerides, as mentioned in the 2019 WSES guidelines 1. The diagnosis should be made promptly as pancreatitis can range from mild and self-limiting to severe with life-threatening complications. The underlying cause should also be identified, with common etiologies including:
- Gallstones
- Alcohol use
- Medications
- Hypertriglyceridemia
- Post-ERCP inflammation, as stated in the 2019 WSES guidelines 1 and the AGA institute medical position statement on acute pancreatitis 1. Early diagnosis allows for appropriate management including fluid resuscitation, pain control, and monitoring for complications. It is essential to consider other life-threatening conditions and exclude them, such as mesenteric ischemia, visceral perforation, and leaking abdominal aortic aneurysm, as mentioned in the United Kingdom guidelines for the management of acute pancreatitis 1. The 2019 WSES guidelines 1 and other studies 1 emphasize the importance of prompt diagnosis and management to improve outcomes in patients with pancreatitis.
From the Research
Diagnostic Criteria for Pancreatitis
The diagnosis of pancreatitis depends on a combination of clinical assessment and laboratory testing, including:
- Serum amylase and lipase levels, with lipase being more sensitive and having a larger diagnostic window than amylase 2
- Characteristic clinical presentation and laboratory findings, with imaging studies sometimes being necessary for diagnosis 3
- Imaging tests such as ultrasound, computed tomography, magnetic resonance cholangiopancreatography, and endoscopic ultrasound, which can help diagnose complications like pseudocysts, hemorrhage, and necrosis 4, 5
Laboratory Tests
Laboratory tests used to diagnose pancreatitis include:
- Serum amylase, which is widely used but has limitations in sensitivity and specificity 6
- Serum lipase, which is more sensitive and specific than amylase, especially in patients with alcohol-induced acute pancreatitis 6, 2
- Urinary test strip that uses trypsinogen-2, which may have a role in establishing the diagnosis of acute pancreatitis 6
Imaging Studies
Imaging studies are sometimes necessary to diagnose pancreatitis, especially in cases where the diagnosis is unclear or complications are suspected. These studies include:
- Ultrasound, which can help diagnose gallstones and other causes of pancreatitis 4
- Computed tomography, which can help diagnose complications like pseudocysts and necrosis 4
- Magnetic resonance cholangiopancreatography, which can help diagnose chronic pancreatitis and its severity 5
- Endoscopic ultrasound, which can help diagnose complications like pseudocysts and hemorrhage 4