Acute pancreatitis diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Diagnosis
According to the American college of gastroenterology, following are the diagnostic guidelines for acute pancreatitis:[1][2][3][4][4][5][6][7][8][9][10]
| 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. | Moderate | Strong |
| 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. | Low | Strong |
Ranson Criteria
It was introduced in 1974.[11] It is a clinical prediction rule for predicting the severity of acute pancreatitis.
Usage
Parameters used:
At admission:
- Age in years >55years
- 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
- Hypocalcemia (serum calcium < 2.0 mmol/L (<8.0 mg/dL))
- Hypoxemia (PO2 < 60 mmHg)
- Base deficit > 4Meq/L
- Estimated fluid sequestration > 6L
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:
At admission:
- Age in years > 70 years
- White blood cell count > 18000 cells/mm3
- Blood glucose > 12.2 mmol/L (> 220 mg/dL)
- Serum AST > 250 IU/L
- Serum LDH > 400 IU/L
At 48 hours:
- Hematocrit fall > 10%
- Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)
- Oxygen (hypoxemia PO2 < 60 mmHg)
- BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration
- Base deficit (negative base excess) > 5 mEq/L
- Sequestration of fluids > 4 L
Interpretation
- If the score >=3, severe pancreatitis likely.
- If the score < 3, severe pancreatitis is unlikely
Or
- Score 0 to 2 : 2% mortality
- Score 3 to 4 : 15% mortality
- Score 5 to 6 : 40% mortality
- Score 7 to 8 : 100% mortality
References
- ↑ Tenner S, Baillie J, DeWitt J, Vege SS, American College of Gastroenterology (2013). "American College of Gastroenterology guideline: management of acute pancreatitis". Am J Gastroenterol. 108 (9): 1400–15, 1416. doi:10.1038/ajg.2013.218. PMID 23896955.
- ↑ Clavien PA, Robert J, Meyer P, Borst F, Hauser H, Herrmann F, Dunand V, Rohner A (1989). "Acute pancreatitis and normoamylasemia. Not an uncommon combination". Ann. Surg. 210 (5): 614–20. PMC 1357795. PMID 2479346.
- ↑ Winslet M, Hall C, London NJ, Neoptolemos JP (1992). "Relation of diagnostic serum amylase levels to aetiology and severity of acute pancreatitis". Gut. 33 (7): 982–6. PMC 1379418. PMID 1379569.
- ↑ 4.0 4.1 Malka D, Rosa-Hézode I (2001). "[Positive and etiological diagnosis of acute pancreatitis]". Gastroenterol. Clin. Biol. (in French). 25 (1 Suppl): 1S153–68. PMID 11223588.
- ↑ McColl KE (2005). "When saliva meets acid: chemical warfare at the oesophagogastric junction". Gut. 54 (1): 1–3. doi:10.1136/gut.2004.047126. PMC 1774376. PMID 15591495.
- ↑ Lippi G, Valentino M, Cervellin G (2012). "Laboratory diagnosis of acute pancreatitis: in search of the Holy Grail". Crit Rev Clin Lab Sci. 49 (1): 18–31. doi:10.3109/10408363.2012.658354. PMID 22339380.
- ↑ Balthazar EJ (2002). "Acute pancreatitis: assessment of severity with clinical and CT evaluation". Radiology. 223 (3): 603–13. doi:10.1148/radiol.2233010680. PMID 12034923.
- ↑ Arvanitakis M, Delhaye M, De Maertelaere V, Bali M, Winant C, Coppens E, Jeanmart J, Zalcman M, Van Gansbeke D, Devière J, Matos C (2004). "Computed tomography and magnetic resonance imaging in the assessment of acute pancreatitis". Gastroenterology. 126 (3): 715–23. PMID 14988825.
- ↑ Bollen TL, Singh VK, Maurer R, Repas K, van Es HW, Banks PA, Mortele KJ (2011). "Comparative evaluation of the modified CT severity index and CT severity index in assessing severity of acute pancreatitis". AJR Am J Roentgenol. 197 (2): 386–92. doi:10.2214/AJR.09.4025. PMID 21785084.
- ↑ Stimac D, Miletić D, Radić M, Krznarić I, Mazur-Grbac M, Perković D, Milić S, Golubović V (2007). "The role of nonenhanced magnetic resonance imaging in the early assessment of acute pancreatitis". Am. J. Gastroenterol. 102 (5): 997–1004. doi:10.1111/j.1572-0241.2007.01164.x. PMID 17378903.
- ↑ 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. PMID 4834279.