From the Guidelines
The diagnostic criteria for pancreatitis require at least two of the following: 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.
Diagnostic Criteria
- Abdominal pain consistent with pancreatitis
- Biochemical evidence of pancreatitis, including:
- Serum amylase greater than three times the upper limit of normal
- Serum lipase greater than three times the upper limit of normal, which is somewhat more specific than amylase 1
- Characteristic findings from abdominal imaging, such as computed tomography (CT) of the abdomen using intravenous contrast enhancement 1
Laboratory Parameters
- The cut-off value of serum amylase and lipase is normally defined to be three times the upper limit 1
- Other laboratory parameters, such as C-reactive Protein, Hematocrit, Urea, Procalcitonin, serum triglyceride, and calcium levels, can be used as prognostic factors or to determine the etiology of pancreatitis 1
Clinical Considerations
- The diagnosis of acute pancreatitis should be established within 48 hours of admission 1
- Patients with unexplained multiorgan failure or the systemic inflammatory response syndrome should be considered for acute pancreatitis 1
- Early CT (within 72 hours of illness onset) might underestimate the amount of pancreatic necrosis 1 According to the 2019 WSES guidelines for the management of severe acute pancreatitis 1, the diagnosis of acute pancreatitis requires a combination of clinical, laboratory, and imaging findings. The guidelines also emphasize the importance of early diagnosis and treatment to improve outcomes in patients with severe acute pancreatitis.
From the Research
Diagnostic Criteria for Pancreatitis
The diagnostic criteria for pancreatitis, as stated in the studies 2, 3, 4, 5, include:
- Upper abdominal pain
- Serum amylase or lipase level greater than three times the upper limit of normal
- Characteristic findings on imaging studies
Revised Atlanta Classification
The revised Atlanta classification, mentioned in 2, is used to diagnose acute pancreatitis, requiring the presence of at least two of the three criteria.
Imaging Studies
Imaging studies, such as computed tomography, can be useful in assessing the severity of pancreatitis or if the diagnosis is uncertain, but are not required to diagnose acute pancreatitis 2, 6.
Scoring Systems
Several scoring systems, including the Ranson criteria and the Bedside Index of Severity in Acute Pancreatitis score, can be used to predict disease severity, as mentioned in 4.
Normoenzymatic Presentation
In some cases, patients with acute pancreatitis may present with normal amylase and lipase levels, creating a diagnostic challenge, as discussed in 3.