According to the American college of gastroenterology, following are the diagnostic guidelines for acute pancreatitis:<ref name="pmid23896955">{{cite journal| author=Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology| title=American College of Gastroenterology guideline: management of acute pancreatitis. | journal=Am J Gastroenterol | year= 2013 | volume= 108 | issue= 9 | pages= 1400-15; 1416 | pmid=23896955 | doi=10.1038/ajg.2013.218 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23896955 }}</ref><ref name="pmid2479346">{{cite journal |vauthors=Clavien PA, Robert J, Meyer P, Borst F, Hauser H, Herrmann F, Dunand V, Rohner A |title=Acute pancreatitis and normoamylasemia. Not an uncommon combination |journal=Ann. Surg. |volume=210 |issue=5 |pages=614–20 |year=1989 |pmid=2479346 |pmc=1357795 |doi= |url=}}</ref><ref name="pmid1379569">{{cite journal |vauthors=Winslet M, Hall C, London NJ, Neoptolemos JP |title=Relation of diagnostic serum amylase levels to aetiology and severity of acute pancreatitis |journal=Gut |volume=33 |issue=7 |pages=982–6 |year=1992 |pmid=1379569 |pmc=1379418 |doi= |url=}}</ref><ref name="pmid11223588">{{cite journal |vauthors=Malka D, Rosa-Hézode I |title=[Positive and etiological diagnosis of acute pancreatitis] |language=French |journal=Gastroenterol. Clin. Biol. |volume=25 |issue=1 Suppl |pages=1S153–68 |year=2001 |pmid=11223588 |doi= |url=}}</ref><ref name="pmid11223588">{{cite journal |vauthors=Malka D, Rosa-Hézode I |title=[Positive and etiological diagnosis of acute pancreatitis] |language=French |journal=Gastroenterol. Clin. Biol. |volume=25 |issue=1 Suppl |pages=1S153–68 |year=2001 |pmid=11223588 |doi= |url=}}</ref><ref name="pmid15591495">{{cite journal |vauthors=McColl KE |title=When saliva meets acid: chemical warfare at the oesophagogastric junction |journal=Gut |volume=54 |issue=1 |pages=1–3 |year=2005 |pmid=15591495 |pmc=1774376 |doi=10.1136/gut.2004.047126 |url=}}</ref><ref name="pmid22339380">{{cite journal |vauthors=Lippi G, Valentino M, Cervellin G |title=Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail |journal=Crit Rev Clin Lab Sci |volume=49 |issue=1 |pages=18–31 |year=2012 |pmid=22339380 |doi=10.3109/10408363.2012.658354 |url=}}</ref><ref name="pmid12034923">{{cite journal |vauthors=Balthazar EJ |title=Acute pancreatitis: assessment of severity with clinical and CT evaluation |journal=Radiology |volume=223 |issue=3 |pages=603–13 |year=2002 |pmid=12034923 |doi=10.1148/radiol.2233010680 |url=}}</ref><ref name="pmid14988825">{{cite journal |vauthors=Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, Jeanmart J, Zalcman M, Van Gansbeke D, Devière J, Matos C |title=Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis |journal=Gastroenterology |volume=126 |issue=3 |pages=715–23 |year=2004 |pmid=14988825 |doi= |url=}}</ref><ref name="pmid21785084">{{cite journal |vauthors=Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ |title=Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis |journal=AJR Am J Roentgenol |volume=197 |issue=2 |pages=386–92 |year=2011 |pmid=21785084 |doi=10.2214/AJR.09.4025 |url=}}</ref><ref name="pmid17378903">{{cite journal |vauthors=Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V |title=The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis |journal=Am. J. Gastroenterol. |volume=102 |issue=5 |pages=997–1004 |year=2007 |pmid=17378903 |doi=10.1111/j.1572-0241.2007.01164.x |url=}}</ref><ref name="pmid11713955">{{cite journal |vauthors=Lankisch PG, Assmus C, Lehnick D, Maisonneuve P, Lowenfels AB |title=Acute pancreatitis: does gender matter? |journal=Dig. Dis. Sci. |volume=46 |issue=11 |pages=2470–4 |year=2001 |pmid=11713955 |doi= |url=}}</ref><ref name="pmid11893928">{{cite journal |vauthors=Gullo L, Migliori M, Oláh A, Farkas G, Levy P, Arvanitakis C, Lankisch P, Beger H |title=Acute pancreatitis in five European countries: etiology and mortality |journal=Pancreas |volume=24 |issue=3 |pages=223–7 |year=2002 |pmid=11893928 |doi= |url=}}</ref><ref name="pmid19281696">{{cite journal |vauthors=Lowenfels AB, Maisonneuve P, Sullivan T |title=The changing character of acute pancreatitis: epidemiology, etiology, and prognosis |journal=Curr Gastroenterol Rep |volume=11 |issue=2 |pages=97–103 |year=2009 |pmid=19281696 |doi= |url=}}</ref><ref name="pmid22613906">{{cite journal |vauthors=Yadav D, O'Connell M, Papachristou GI |title=Natural history following the first attack of acute pancreatitis |journal=Am. J. Gastroenterol. |volume=107 |issue=7 |pages=1096–103 |year=2012 |pmid=22613906 |doi=10.1038/ajg.2012.126 |url=}}</ref><ref name="pmid7811319">{{cite journal |vauthors=Steinberg W, Tenner S |title=Acute pancreatitis |journal=N. Engl. J. Med. |volume=330 |issue=17 |pages=1198–210 |year=1994 |pmid=7811319 |doi=10.1056/NEJM199404283301706 |url=}}</ref><ref name="pmid3375232">{{cite journal |vauthors=Simpson WF, Adams DB, Metcalf JS, Anderson MC |title=Nonfunctioning pancreatic neuroendocrine tumors presenting as pancreatitis: report of four cases |journal=Pancreas |volume=3 |issue=2 |pages=223–31 |year=1988 |pmid=3375232 |doi= |url=}}</ref><ref name="pmid2437571">{{cite journal |vauthors=Köhler H, Lankisch PG |title=Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma |journal=Pancreas |volume=2 |issue=1 |pages=117–9 |year=1987 |pmid=2437571 |doi= |url=}}</ref><ref name="pmid3594134">{{cite journal |vauthors=Robertson JF, Imrie CW |title=Acute pancreatitis associated with carcinoma of the ampulla of Vater |journal=Br J Surg |volume=74 |issue=5 |pages=395–7 |year=1987 |pmid=3594134 |doi= |url=}}</ref>
According to the American college of gastroenterology, following are the diagnostic guidelines for acute pancreatitis:<ref name="pmid11223588">{{cite journal |vauthors=Malka D, Rosa-Hézode I |title=[Positive and etiological diagnosis of acute pancreatitis] |language=French |journal=Gastroenterol. Clin. Biol. |volume=25 |issue=1 Suppl |pages=1S153–68 |year=2001 |pmid=11223588 |doi= |url=}}</ref>
It was introduced in 1974.<ref name="pmid4834279">{{cite journal |author=Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC |title=Prognostic signs and the role of operative management in acute pancreatitis |journal=Surgery, gynecology & obstetrics |volume=139 |issue=1 |pages=69-81 |year=1974 |pmid=4834279 |doi=}}</ref> It is a [[clinical prediction rule]] for predicting the severity of [[acute pancreatitis]].
===Ranson criteria for predicting the severity of acute pancreatitis===
Ranson criteria was introduced in 1974. It is a [[clinical prediction rule]] for predicting the severity of [[acute pancreatitis]]. The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.<ref name="pmid4834279">{{cite journal |author=Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC |title=Prognostic signs and the role of operative management in acute pancreatitis |journal=Surgery, gynecology & obstetrics |volume=139 |issue=1 |pages=69-81 |year=1974 |pmid=4834279 |doi=}}</ref>
==Usage==
=== Interpretation of Ranson criteria for predicting the severity of acute pancreatitis ===
Parameters used:
*Score 0 to 2 : Severe pancreatitis is unlikely; 2% mortality
*Score 3 to 4 : Severe pancreatitis is likely; 15% mortality
At admission:
*Score 5 to 6 : Severe pancreatitis is likely; 40% mortality
# Age in years >55years
*Score 7 to 8 : Severe pancreatitis is likely; 100% mortality
# White blood cell count > 16000/mcL
# Blood glucose > 11 mmol/L (>200 mg/dL)
# Serum AST > 250 IU/L
# Serum LDH > 350 IU/L
After 48 hours:
# Haematocrit fall > 10%
# Increase in BUN by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.
For gallstone pancreatitis:
== For gallstone pancreatitis: ==
'''At admission:'''
'''At admission:'''
# Age in years > 70 years
# Age in years > 70 years
Line 84:
Line 70:
# Base deficit (negative [[base excess]]) > 5 mEq/L
# Base deficit (negative [[base excess]]) > 5 mEq/L
# Sequestration of fluids > 4 L
# Sequestration of fluids > 4 L
==Interpretation==
* If the score >=3, severe pancreatitis likely.
* If the score < 3, severe pancreatitis is unlikely
According to the American college of gastroenterology, the diagnosis of AP is most often established by the presence of two of the three following criteria: abdominal pain consistent with the disease, serum amylase and/or lipase greater than three times the upper limit of normal, and/or characteristic findings from abdominal imaging. Contrast-enhanced computed tomographic (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically within the first 48-72h after hospital admission. Ranson criteria may be used to predict the severity of acute pancreatitis. If the score >=3, severe pancreatitis is likely to be present.
Diagnosis
According to the American college of gastroenterology, following are the diagnostic guidelines for acute pancreatitis:[1]
Recommendation
Evidence Level
Strength of Recommendation
The diagnosis of AP is most often established by the presence of two of the three following criteria: (i) abdominal pain consistent with the disease, (ii) serum amylase and/or lipase greater than three times the upper limit of normal, and/or (iii) characteristic findings from abdominal imaging.
Contrast-enhanced computed tomographic (CECT) and/or magnetic resonance imaging (MRI) of the pancreas should be reserved for patients in whom the diagnosis is unclear or who fail to improve clinically within the first 48-72h after hospital admission.
In the absence of gallstones and/or history of significant history of alcohol use, a serum triglyceride should be obtained and considered the etiology if >1,000 mg/dl
Endoscopic investigation in patients with acute idiopathic pancreatitis should be limited, as the risks and benefits of investigation in these patients are unclear
Ranson criteria for predicting the severity of acute pancreatitis
Ranson criteria was introduced in 1974. It is a clinical prediction rule for predicting the severity of acute pancreatitis. The criteria for point assignment is that a certain breakpoint be met at anytime during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both biliary and alcoholic pancreatitis.[2]
Interpretation of Ranson criteria for predicting the severity of acute pancreatitis
Score 0 to 2 : Severe pancreatitis is unlikely; 2% mortality
Score 3 to 4 : Severe pancreatitis is likely; 15% mortality
Score 5 to 6 : Severe pancreatitis is likely; 40% mortality
Score 7 to 8 : Severe pancreatitis is likely; 100% mortality
↑Malka D, Rosa-Hézode I (2001). "[Positive and etiological diagnosis of acute pancreatitis]". Gastroenterol. Clin. Biol. (in French). 25 (1 Suppl): 1S153–68. PMID11223588.CS1 maint: Unrecognized language (link)
↑Ranson JH, Rifkind KM, Roses DF, Fink SD, Eng K, Spencer FC (1974). "Prognostic signs and the role of operative management in acute pancreatitis". Surgery, gynecology & obstetrics. 139 (1): 69–81. PMID4834279.CS1 maint: Multiple names: authors list (link)