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Old 06-22-2011
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Pancreas Initial and confirmatory diagnositic steps for acute pancreatitis?

in acute pancreatitis
initial next step ix is serum (amylase and lipase )
confirm dx (specific ) ct abdomen

am i right
but uw q say next step ix to confirm most likly dx is serum (amylase and lipase )

correct me if iam wrong
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Old 06-22-2011
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I think just by obtaining the Serum Amylase and lipase level (Which would be over the roof) would pretty much will give u a clear pic that you are dealing with AP. I dont think we need a CT, unless there is a assoc pseudo cyst!
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Old 06-23-2011
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[B]Hi Miss Patho,

I checked what UpToDate had to say on this issue and I did not find a simple answer to your question.

"Acute pancreatitis can be suspected clinically, but requires biochemical, radiologic, and sometimes histologic evidence to confirm the diagnosis. Clinical, biochemical, and radiologic features need to be considered together since none of them alone is diagnostic of acute pancreatitis."

The following contains info I found in both UpToDate and Cecil Essentials of Medicine.

Serum Amylase

Serum amylase is the most frequently ordered test to diagnose acute pancreatitis. It rises within 6 to 12 hours of onset, and is cleared fairly rapidly from the blood (half-life approximately 10 hours). In uncomplicated attacks, serum amylase is usually elevated for three to five days.

The sensitivity of serum amylase for detecting acute pancreatitis is difficult to assess because an elevated amylase concentration is often required to make the diagnosis. ISubstantial elevations in serum amylase (more than two times the upper limit of normal) may, for reasons that are not well understood, be less common in patients with hypertriglyceridemia-associated pancreatitis.

An elevated serum amylase level is a nonspecific finding because it occurs in a number of conditions other than acute pancreatitis such as parotitis and tubo-ovarian disease. The serum amylase concentration in acute pancreatitis is usually more than three times the upper limit of normal. However, the serum amylase may also be normal or only minimally elevated.

Serum Lipase

The sensitivity of serum lipase for the diagnosis of acute pancreatitis ranges from 85 to 100 percent in various reports. Lipase measurement is more specific than serum amylase and urinary total amylase in diagnostic accuracy both on day one and day three. However, nonspecific elevations of lipase have been reported in almost as many diseases as amylase. Since serum lipase remains elevated for 3-5 days, serum lipase levels may be especially useful in patients with alcoholic pancreatitis presenting late to the physician.

Controversy exists about the clinical utility of combining amylase and lipase for improving diagnostic accuracy for acute pancreatitis. Many have found that the combination of enzymes does not improve diagnostic accuracy.

It's important to note that daily measurement of enzymes has no value in assessing the clinical progress or prognosis since the level of pancreatic enzyme elevation does not correlate with severity of disease.

CT Imaging

CT scan is the most important imaging test for the diagnosis of acute pancreatitis and its intraabdominal complications and also for assessment of severity. While CT scanning can be used to confirm a diagnosis of pancreatitis (pancreatic enlargement, peripancreatic inflammatory changes, and extrapancreatic fluid collections), it can actually be normal in 15-30% of mild cases. Patients with clinical and biochemical features of acute pancreatitis who do not improve with initial conservative therapy or who are suspected of having complications or other diagnoses should undergo CT scan of the abdomen.
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