Acute pancreatitis presents with severe epigastric pain radiating to the back, nausea, vomiting, fever, and tenderness. Laboratory tests show elevated levels of serum amylase and lipase, which are markers for acute pancreatitis. While elevated levels of these enzymes are used in the initial diagnosis of acute pancreatitis, the degree of elevation does not correlate with the severity of the condition. Serum lipase rises later than amylase and takes longer to return to normal levels, making it a more specific indicator of pancreatic injury. Imaging tests like abdominal ultrasound and CT scans are also used to identify complications of acute pancreatitis like pseudocysts or abscesses.

1. Acute
pancreatitis
NAME: CHEONG YEAT YANG
STUDENT NO: 0317453
BATCH: 10

2. Learning issues:
 Clinical presentation of acute pancreatitis and compare it with other causes
upper abdominal pain
 Investigations of acute pancreatitis and discuss role and limitation of
serum amylase

3. Clinical presentations
Symptoms and signs
The most common symptoms and signs include:
 Severe epigastric pain radiating to the back, relieved by leaning forward
 Nausea, vomiting, diarrhea and loss of appetite
 Fever/chills
 Hemodynamic instability, including shock
 In severe case may present with tenderness, guarding, rebound.
Signs which are less common, and indicate severe disease, include:
 Grey-Turner's sign (hemorrhagic discoloration of the flanks)
 Cullen's sign (hemorrhagic discoloration of the umbilicus)

4. Other causes of abdominal pain:

5. Lab investigations
 Full blood count: neutrophil leucocytosis
 Electrolyte abnormalities include hypokaemia, hypocalcemia
 Elevated LDH in biliary disease
 Glycosuria ( 10% of cases)
 Blood sugar: hyperglycaemia in severe cases
 Ultrasound look for stones in biliary tract diseases.
 Abdominal CT scan may reveal phlegmon (inflammatory mass), pseudocyst
or abscess( complications of acute pancreatitis)

6. Lab investigations
Amylase and lipase
 Elevated serum amylase and lipase levels, in combination with severe
abdominal pain, often trigger the initial diagnosis of acute pancreatitis.
 Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes
within 7 to 14 days after treatment.
 Marked elevation of serum amylase level during first 24 hours
 Reasons for false positive elevated serum amylase include salivary gland
disease (elevated salivary amylase) and macroamylasemia.
 If the lipase level is about 2.5 to 3 times that of Amylase, it is an indication of
pancreatitis due to Alcohol or gallstone
 The degree of amylase/lipase elevation does not correlate with severity of
acute pancreatitis.

7. References
 Davidson’s principles and practice of medicine 22nd edition
 Short textbook of medical diagnosis and management 11th international
edition (Inam Danish)

8. Thank you