Acute Pancreatitis

• Definition
• Inflammation of the pancreas
• Associated with edema, pancreatic autodigestion, necrosis and possible hemorrhage
• Clinical Manifestations
• Abdominal pain, usually epigastric, severe, constant with radiation to the back
• Associated nausea and vomiting
• May also have fever, ileus, tachycardia and in severe cases, hypovolemic shock
• The inflammatory process around the pancreas may cause other signs and symptoms such as:
• pleural effusion
• Grey Turner's sign ( flank discoloration )
• Cullen's sign ( discoloration around the umbilicus )
• ascites
• jaundice
• Risk factors associated with pancreatitis
• Alcohol abuse
• Cholelithiasis
• Drugs ( valproic acid, tetracycline, hydrochlorothiazide, furosemide )
• Pancreatic cancer
• Abdominal trauma/surgery
• Ulcer with pancreatic involvement
• Familial pancreatitis
• Diagnosis
• Based on clinical presentation, history, physical and labs
• The common labs that are obtained are serum amylase, serum lipase and urine amylase
• Serum amylase
• serum amylase rises rapidly, usually within hours after an attack
• serum amylase remains elevated for approximately four days
• reference range in adults for serum amylase is 0-140 U/dL
• amylase is detected enzymatically
• Serum lipase
• serum lipase also rises rapidly, within hours after an attack
• serum lipase also remains elevated for approximately four days
• reference range for serum lipase is ,130 U/l
• lipase is measured via turbidimetric method:
• lipase catalyzes the hydrolysis of triglycerides to monoglyceride and two free fatty acids
• the turbidity test is based on measurement of the clearance of a substrate emulsion by lipase:

                                      lipase
			cloudy emulsion ------> glycerides + free fatty acids
			           (clear solution )

• Urine amylase
• urine amylase rises a few hours after the rise sin serum amylase and lipase
• urine amylase remains elevated for approximately seven to ten days
• the rise in urine amylase is secondary to an increase in the renal clearance of amylase
• Amylase clearance is used to differentiate between a patient with macroamylasemia secondary to hyperamylasemia from a patient with pancreatitis
• normal ratio for amylase clearance is between 2-5%
• in macroamylasemia, the ratio is decreased
• in pancreatitis, the ratio is increased

1. Clinical Laboratory Medicine; K. McClatchey
2. ABC's of Interpretive Laboratory Data, 3rd ed.; Bakerman
3. Cecil's Essentials of Medicine, 3rd ed.