Acute pancreatitis diagnostic criteria
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sadaf Sharfaei M.D.[2]
Overview
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. | 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 |
| Transabdominal ultrasound should be performed in all patients with acute pancreatitis | Low | Strong |
| 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 | Moderate | Conditional |
| In a patient older than 40 years, a pancreatic tumor should be considered as a possible cause of acute pancreatitis | Low | Conditional |
| Endoscopic investigation in patients with acute idiopathic pancreatitis should be limited, as the risks and benefits of investigation in these patients are unclear | Low | Conditional |
| Patients with idiopathic pancreatitis should be referred to centers of expertise | Low | Conditional |
| Genetic testing may be considered in young patients (<30 years old) if no cause is evident and a family history of pancreatic disease is present | Low | Conditional |
Ranson criteria 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