JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis

Abstract

-Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected acute pancreatitis. -Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing acute pancreatitis and its intraperitoneal complications. -Computed tomography (CT) is also one of the most important imaging procedures for diagnosing acute pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of acute pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the pancreatitis is unknown. -When acute pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by acute pancreatitis are present. -Because the etiology of acute pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced acute pancreatitis, which requires treatment of the biliary system, and alcohol-induced acute pancreatitis, which requires a different form of treatment. Key words AbstractThe currently used diagnostic criteria for acute pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with acute pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of acute pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations:-Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of acute pancreatitis and its differentiation from other diseases. -A pivotal factor in the diagnosis of acute pancreatitis is identifying an increase in pancreatic enzymes in the blood.

Prediction of Post-ERCP Pancreatitis

“…Several studies (20)(21)(22)(23)(24) have demonstrated that the serum lipase level is more sensitive indicator than the serum amylase level for diagnosing other forms of acute pancreatitis, but only a few studies (25)(26)(27)) have compared measurements of various pancreatic enzymes as a means of predicting post-ERCP pancreatitis. Moreover, it is still unclear whether there are differences in the diagnostic accuracy of pancreatic enzyme levels for predicting post-ERCP pancreatitis according to the procedures, in other words, whether the ERCP is diagnostic or therapeutic.…”

Contemporary Management of Acute Biliary Pancreatitis

“…Acute pancreatitis sometimes cause color change in the skin in side abdominal wall(Grey Turner's sign), around the belly(Cullen's sign), or on the lower part of inguinal ligament(Fox's sign) [7]. Abdominal pain is observed in approximately 95% of the cases.…”

“…The diagnosis of acute pancreatitis is made if at least two of the following three criteria are met: 1-Acute abdominal pain 2-Elevated pancreatic enzyme levels in blood, urine or acidic liquid 3-Abnormal imaging findings in pancreas that are related with acute pancreatitis.If the diagnosis is made on this basis, other pancreatic diseases and acute abdomen reasons can be ruled out [7].Distinguishing between acut biliary pancreatitis and other causes of acute pancreatitis is important for disease management and prognosis.…”

“…While most of the attacks in acute pancreatic inflammation are edematous/mild acute pancreatitis that regresses in 5-7 days, necrotizing/severe acute pancreatitis that may lead to mortality may develop in approximately 20% of the cases [45].Therefore, all patients with acute pancreatitis should be hospitalized and given initial supportive care, their disease etiologies should be evaluated and resolved, the severity of pancreatitis should be evaluated, and advanced treatment approach should be planned in accordance with the disease severity (Figure) [7,21,22].…”

Clinical outcomes in patients with ICU-related pancreatitis

“…In this study, acute pancreatitis was diagnosed in patients meeting at least two of the following three criteria as previously described [18] : (1) acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme (serum lipase and/or amylase) in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings for the pancreas associated with acute pancreatitis. A search of medical records using a combination of the two diagnostic categories of acute respiratory failure and acute pancreatitis identified 163 patients.…”