Pancreatitis, acute diagnosis

The cause of the overproduction of VLDL triglyceride is unknown. The administration of estrogen and corticosteroids aggravates hypertriglyceridemia in these patients and can sometimes lead to acute pancreatitis. The diagnosis of FHTG requires study of other family members to differentiate this disorder from FCHL. This disorder appears to be inherited in an autosomal dominant pattern with a delayed expression and an estimated frequency in the population at about 1 500 persons. About one in five children born to affected parents manifest the phenotype early in life. ... 

Amylase enters the blood largely via the lymphatics. An increase in hydrostatic pressure in the pancreatic ducts leads to a fairly prompt rise in the amylase concentration of the blood. Neither an increase in volume flow of pancreatic juice nor stimulation of pancreatic enzyme production will cause an increase in senm enzyme concentration. Elevation of intraductal pressure is the important determinant. Stimulation of flow in the face of obstruction can, however, augment the entry of amylase into the blood, as can disruption of acinar cells and ducts. A functional pancreas must be present for the serum amylase to rise. Serum amylase determination is indicated in acute pancreatitis in patients with acute abdominal pain where the clinical findings are not typical of other diseases such as appendicitis, cholecystitis, peptic ulcer, vascular disease or intestinal obstruction. In acute pancreatitis, the serum amylase starts to rise within a few hours simultaneously with the onset of symptoms and remains elevated for 2 to 3 days after which it returns to normal. The peak level is reached within 24 hours. Absence of increase in serum amylase in first 24 hours after the onset of symptoms is evidence against a diagnosis of acute pancreatitis (76). 

Diagnosis of acute pancreatitis is based on the patient s history and presenting signs and symptoms. Evaluation of laboratory results, specifically the serum amylase and lipase, aids in diagnosis. Serum amylase is elevated early in the disease process but may return to normal within 12 hours.10 Serum lipase will remain elevated for days after the acute event and may lend itself more to the diagnosis depending on when the patient presents for evaluation.11... 

The patient has been transferred from the CT scanner to the surgical intensive care unit for mechanical ventilation, blood pressure support, and surgical evaluation. A diagnosis of acute pancreatitis with pancreatic necrosis is made. 

Differentiating an episode of acute pancreatitis from chronic pancreatitis maybe difficult because the clinical presentations can be similar. The diagnosis of chronic pancreatitis is made by looking for the effects of chronic pancreatic inflammation and scarring on the pancreas and the patient as a whole. Computed tomography or ERCP will allow visualization of chronic calcified lesions in the pancreas when present.37... 

Acute necrotizing pancreatitis (ANP) still remains a life-threatening disease despite several improvements in diagnosis, prevention and treatment. Infectious complica-... 

Dervenis C, Johnson CD, Bassi C, Bradley EL 3rd, Imrie CW, McMahon MJ, Modlin I Diagnosis, objective assessment of severity, and the management of acute pancreatitis. Int JPancreatol 1999,25 195—210. 

Berthier, S., Miehiels, C., Sgro, C., Bonnotte, B. and Lorcerie, B. 2005. Acute nonalcoholic nonbiliary pancreatitis. Difficulties in diagnosis and possibility of nicotine toxieity. Presse Medicale, 34 795-796. 

CURRENT CONCEPTS ON DIAGNOSIS AND TREATMENT OF ACUTE PANCREATITIS... 

Recent advances in molecular biology and clinical biochemistry allowed for better understanding of the processes involved in the pathogenesis of acute pancreatitis. Many attempts have been made to identify new diagnostic tests that could help in more accurate diagnosis and early prediction of severity. Moreover, several clinical trials applied novel treatment regimens to influence a specific pathway of the inflammatory process. The aim of this chapter is to review current concepts on diagnosis and treatment of acute pancreatitis. 

Laboratory Tests Used in the Diagnosis and Differentiation of Acute Pancreatitis (AP) From Other Acute Abdominal Diseases... 

Clinical Efficiency of Tests in the Diagnosis of Acute Pancreatitis ... 

Magnetic resonance imaging is comparable to CT in its capacity to diagnose acute pancreatitis and provide precise information regarding the severity of the disease (A4, L9, P10, R12). However, due to the limited availability for emergency diagnosis it has not been widely used for routine clinical practice. 

D8. Dominguez-Munoz, J. E., Diagnosis of acute pancreatitis Any news or still amylase In Acute Pancreatitis, Novel Concepts in Biology and Therapy (M. W. Biichler, W. Uhl, H. Friess, and P. Malfertheiner, eds.), Vol. 1, pp. 171-179. Blackwell, Oxford, 1999. 

L16. Lott, J. A., and Lu, C. J., Lipase isoforms and amylase isoenzymes Assays and application in the diagnosis of acute pancreatitis. Clin. Chem. 57, 66-68 (1991). 

Ml. Malfertheiner, P., and Kemmer, T. P., Clinical picture and diagnosis of acute pancreatitis. 

P8. Pezzilli, R., Morselli-Labate, A. M., Miniero, R., Barakat, B., Fiocchi, M., and Cappelletti, O., Simultaneous serum assayed lipase and interleukin-6 for early diagnosis and prognosis of acute pancreatitis. Clin. Chem. 45, 1762-1767 (1999). 

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