A 38-year-old alcoholic woman presents with complaints of epigastric pain radiating to her back with nausea and vomiting. Physical exam reveals epigastric tenderness.
What is the most likely diagnosis?
Correct Answer B:
Acute pancreatitis is inflammation of the pancreas (and, sometimes, adjacent tissues) caused by the release of activated pancreatic enzymes. The most common triggers are biliary tract disease and chronic heavy alcohol intake. The condition ranges from mild (abdominal pain and vomiting) to severe (pancreatic necrosis and a systemic inflammatory process with shock and multiorgan failure).
Diagnosis is based on clinical presentation and serum amylase and lipase levels. Treatment is supportive, with IV fluids, analgesics, and fasting.
A 60-year-old man is seen in the emergency room and is diagnosed as having acute pancreatitis.
Which one of the following results of the assessment on admission would suggest more severe illness?
Ranson’s criteria for predicting the mortality of a patient involves assessment on admission and then again at 48 hours, with the following criteria:
1- On Admission:
2- At 48 hours After Admission:
Of the answer choices, on admission a high glucose level would contribute to this patients mortality.
A 60-year-old man is admitted to the hospital because of acute pancreatitis.
Laboratory studies show:
After 48 hours of fluid therapy and observation, a poor prognosis would be indicated by which of the following laboratory studies?
Correct Answer D:
Of the listed laboratory abnormalities (elevated ALT, amylase, bilirubin, and glucose) the one that is most suggestive of severe pancreatic inflammation, and even necrosis, is hypocalcemia. This is presumably due to the results of saponification of calcium by released fatty acids.
A 45-year-old white male presents with a 3-day history of new-onset acute upper abdominal pain radiating to the back. His pulse rate is 110 beats/min and other vital signs are normal. Bowel sounds are hypo-active and epigastric tenderness without guarding is present.
Which one of the following is most accurate regarding laboratory testing for possible pancreatitis in this situation?
A serum lipase level is a more specific test for pancreatitis than an amylase level. Amylase is more likely to be elevated in other acute abdominal conditions. Amylase levels may also be elevated with salivary gland abnormalities, chronic sialadenitis, renal failure, and liver disease.
Although elevated triglyceride levels are associated with pancreatitis, patients with hypertriglyceridemia and proven pancreatitis have been found to have deceptively low levels of amylase, and sometimes of lipase activity. There is no significant correlation between the magnitude of serum amylase elevation and the severity of pancreatitis. In fact, a milder form of acute pancreatitis is often associated with higher levels of serum amylase than those seen in a more severe form of the disease. Serum trypsinogen is secreted specifically by the pancreas and is helpful in determining when elevated amylase levels are coming from non-pancreatic sources. Because amylase, lipase, and trypsinogen are all cleared by the kidneys, renal failure, particularly with a creatinine clearance < 50 mL/min, may result in delayed clearance and false elevations of enzymes.
When considering a diagnosis of pancreatitis, amylase levels:
Amylase and lipase levels are used to help make the diagnosis of acute pancreatitis. The serum lipase level is more specific and more sensitive than the amylase level. Amylase elevations can be seen with other abdominal illnesses, such as inflammation of the small bowel. Alcoholics with recurrent pancreatitis may have normal serum amylase levels; in such cases, serum lipase would be a better test.
There are several scoring systems for the severity of pancreatitis, including the CT severity index, the APACHE II score, the Imrie Scoring System, and Ranson’s Criteria, but none of these use serum amylase in their calculation. The elevation of serum amylase does not correspond well with the severity of the pancreatitis.
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