From the Guidelines
The diagnosis of pancreatitis requires at least two of the three following criteria: abdominal pain consistent with the disease, biochemical evidence of pancreatitis (serum amylase and/or lipase greater than three times the upper limit of normal), and characteristic findings from abdominal imaging. The abdominal pain typically presents as severe epigastric pain that may radiate to the back 1. 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 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), liver function tests, and triglyceride levels 1.
Some key points to consider in the diagnosis of pancreatitis include:
- The cut-off value of serum amylase and lipase is normally defined to be three times the upper limit 1
- 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
- Urea > 20 mg/dl represents itself as an independent predictor of mortality 1
- Procalcitonin is the most sensitive laboratory test for detection of pancreatic infection, and low serum values appear to be strong negative predictors of infected necrosis 1
It is essential to identify and address the underlying cause of pancreatitis, such as gallstones, alcohol use, or medications, to guide proper treatment and prevention of recurrence 1. The diagnosis should be made promptly to guide appropriate management, which varies based on severity and etiology.
From the Research
Diagnostic Criteria for Pancreatitis
The diagnostic criteria for pancreatitis, specifically acute pancreatitis, are based on the fulfillment of at least two out of three criteria:
- Abdominal pain, often radiating to the back 2, 3, 4
- Serum lipase or amylase levels three or more times the upper limit of the normal level 2, 3, 4, 5
- Findings indicating pancreatitis obtained via a computed tomography (CT) scan or magnetic resonance imaging (MRI) 2, 3, 4, 6
Laboratory Tests
Laboratory tests play a crucial role in the diagnosis of acute pancreatitis, including:
- Serum amylase and lipase analysis 2, 3, 4, 5
- Lipid panel, including triglycerides 2
- Analysis of immunoglobulins 2
- Full blood count, electrolyte analysis, and hemoglobin A1c test 2
- Urinary test strip that uses trypsinogen-2 5
Imaging Studies
Imaging studies, such as CT scans and MRI, are useful in assessing the severity of acute pancreatitis and confirming the diagnosis 2, 3, 4, 6. However, imaging is not required to diagnose acute pancreatitis 3.
Etiologies
The different etiologies of acute pancreatitis include: