Diagnostic studies-acute pancreatitis

(Am J Gastro 2013;108:1400)

• Dx requires 2 of 3: characteristic abd pain; lipase or amylase >3× ULN; ⊕ imaging

• Laboratory: levels of amylase & lipase do not correlate w/ severity of disease

↑ amylase: rises w/in hrs, normalizes w/in 3-5 d (faster than lipase)

false ⊖: 20% EtOH pancreatitis; 50% hypertriglyceridemia (assay interference)

false ⊕: other abd or salivary gland process, acidemia, ↓ GFR, macroamylasemia

↑ lipase: longer t½ than amylase

3× ULN 99% sensitive, 99% specific for acute pancreatitis

10k has 80% PPV for biliary dx, 99% NPV for EtOH (Dig Dis Sci 2011;56:3376)

false ⊕: renal failure, other abd process, DKA, HIV, macrolipasemia

ALT >3× ULN has 95% PPV for gallstone pancreatitis (Am J Gastro 1994;89:1863)

Imaging studies of acute pancreatitis