<unk>  is diagnosed using clinical history and physical examination, based on the presence of at least 2 of 3 criteria: abdominal pain, elevated serum lipase or amylase, and abdominal imaging findings consistent with<unk> . Additional blood studies are used to identify organ failure, offer prognostic information, and determine if fluid resuscitation is adequate and whether ERCP is necessary. * Blood investigations – complete blood count, kidney function tests, liver function, serum calcium, serum amylase and lipase * Imaging – A triple phase abdominal CT and abdominal ultrasound are together considered the gold standard for the evaluation of<unk> . Other modalities including the abdominal x-ray lack sensitivity and are not recommended. An important caveat is that imaging during the first 12 hours may be falsely reassuring as the inflammatory and necrotic process usually requires 48 hours to fully manifest. Differential diagnosis The differential diagnosis includes: * Perforated peptic ulcer * Biliary colic * Acute cholecystitis * Pneumonia * Pleuritic pain * Myocardial infarction Biochemical * Elevated serum amylase and lipase levels, in combination with severe abdominal pain, often trigger the initial diagnosis of<unk> . However, they have no role in assessing disease severity. * Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14 days after treatment. * Serum amylase may be normal (in 10% of cases) for cases of acute or chronic pancreatitis (depleted acinar cell mass) and hypertriglyceridemia. * Reasons for false positive elevated serum amylase include salivary gland disease (elevated salivary amylase), bowel obstruction, infarction, cholecystitis, and a perforated ulcer. * If the lipase level is about 2.5 to 3 times that of amylase, it is an indication of pancreatitis due to alcohol. *Decreased serum calcium *Glycosuria Regarding selection on these tests, two practice guidelines state: : "It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase including macroamylasemia, parotitis, and some carcinomas. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of<unk> " : "Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of<unk>  (recommendation grade A)" Most, but not all individual studies support the superiority of the lipase. In one large study, there were no patients with pancreatitis who had an elevated amylase with a normal lipase. Another study found that the amylase could add diagnostic value to the lipase, but only if the results of the two tests were combined with a discriminant function equation. While often quoted lipase levels of 3 or more times the upper-limit of normal is diagnostic of pancreatitis, there are also other differential diagnosis to be considered relating to this rise. Computed tomography Axial CT in a patient with acute exudative pancreatitis showing extensive fluid collections surrounding the pancreas. Regarding the need for computed tomography, practice guidelines state: CT is an important common initial assessment tool for<unk> . Imaging is indicated during the initial presentation if: *the diagnosis of<unk>  is uncertain *there is abdominal distension and tenderness, fever >102 F (38,9 C), or leukocytosis *there is a Ranson score > 3 or<unk> ACHE score > 8 *there is no improvement after 72 hours of conservative medical therapy *there has been an acute change in status: fever, pain, or shock CT is recommended as a delayed assessment tool in the following situations: *acute change in status *to determine therapeutic response after surgery or interventional radiologic procedure *before discharge in patients with severe<unk>  Abdominal CT should not be performed before the first 12 hours of onset of symptoms as early CT (<12 hours) may result in equivocal or normal findings. CT findings can be classified into the following categories for easy recall: *Intrapancreatic – diffuse or segmental enlargement, edema, gas bubbles, pancreatic pseudocysts and phlegmons/abscesses (which present 4 to 6 wks after initial onset) *Peripancreatic / extrapancreatic – irregular pancreatic outline, obliterated peripancreatic fat, retroperitoneal edema, fluid in the lessar sac, fluid in the left anterior pararenal space *Locoregional – Gerota's fascia sign (thickening of inflamed Gerota's fascia, which becomes visible), pancreatic ascites, pleural effusion (seen on basal cuts of the pleural cavity), adynamic ileus, etc. The principal value of CT imaging to the treating clinician is the capacity to identify devitalised areas of the pancreas which have become necrotic due to ischaemia. Pancreatic necrosis can be reliably identified by intravenous contrast-enhanced CT imaging, and is of value if infection occurs and surgical or percutaneous debridement is indicated. Magnetic resonance imaging While computed tomography is considered the gold standard in diagnostic imaging for<unk> , magnetic resonance imaging (MRI) has become increasingly valuable as a tool for the visualization of the pancreas, particularly of pancreatic fluid collections and necrotized debris. Additional utility of MRI includes its indication for imaging of patients with an allergy to CT's contrast material, and an overall greater sensitivity to hemorrhage, vascular complications, pseudoaneurysms, and venous thrombosis. Another advantage of MRI is its utilization of magnetic resonance cholangiopancreatography (MRCP) sequences. MRCP provides useful information regarding the etiology of<unk> , i.e., the presence of tiny biliary stones (choledocholithiasis or cholelithiasis) and duct anomalies. Clinical trials indicate that MRCP can be as effective a diagnostic tool for<unk>  with biliary etiology as endoscopic retrograde cholangiopancreatography, but with the benefits of being less invasive and causing fewer complications. Ultrasound Abdominal ultrasonography of<unk> . On abdominal ultrasonography, the finding of a hypoechoic and bulky pancreas is regarded as diagnostic of<unk> .
Acute pancreatitis
Grey Turner's sign
Gallstone ileus
Chronic pancreatitis
Acute abdomen
Pancreatic abscess
Ascending cholangitis
Pancreatic fistula