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Compiled and edited by AJ
①HISTORY
• Abdominal pain
– Site: upper abdomen
– Acute onset
– Gradually intensifies in severity
– Duration: varies
– Rad...
Don’t forget to ask..
• History of previous biliary colic
• History of alcohol consumption
• Any recent operative or other...
②EXAMINATION
General examination
• Pale
• Diaphoretic
• Listless
• Jaundice (minority of
patients)
Vital signs
• Fever
• T...
Abdominal examination
• Abdominal tenderness
• Muscular guarding
(guarding tends to be
more pronounced in the
upper abdome...
Uncommon physical findings
• Cullen’s sign: bluish
discoloration around the
umbilicus resulting from
hemoperitoneum
• Grey...
③INVESTIGATIONS
LABORATORY
• CBC
– Anemia(hgic), leukocytosis (inflammation, infection)
• Liver enzymes
– ALT if increases...
Laboratory
studies
Serum
amylase
Serum
lipase
C-
reactive
protein
Other
markers
• Pancreatic enzymes (serum amylase and
lipase)
– Serum amylase sensitivity of 81-95% but not
specific for pancreatitis
– ...
• Serum C-Reactive Protein: best marker for
severity
• Trypsinogen and elastase have no significant
advantage over amylase...
IMAGING IN ACUTE PANCREATITIS
Role:
• To clarify the diagnosis when the clinical picture is
confusing
• Help in determine ...
1. Abdominal Ultrasound
• Indicated early in acute pancreatitis
– Pros
• Inexpensive
• Excellent for identifying gallbladd...
2. Abdominal X-ray
• Limited role in acute pancreatitis
• Poor visualization of the pancreas and retroperitoneum
• Most co...
COLON CUT-OFF SIGN
•Markedly distended transverse colon with air
•Absence of gas distal to splenic flexure
SENTINEL LOOP SIGN
Mildly dilated, gas-filled segment of small bowel
with or without air fluid level
3. Contrast-Enhanced CT
• Standard imaging of choice
– Pros
• Aid in diagnosis and staging of pancreatitis
• Evaluate comp...
CTSI
3. MRI
• Increasingly used in diagnosis and management of acute
pancreatitis
– Pros
• alternative in situations in which C...
Diagnosis of Acute Pancreatitis
Diagnosis of Acute Pancreatitis
Diagnosis of Acute Pancreatitis
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Diagnosis of Acute Pancreatitis

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Diagnosis of Acute Pancreatitis

  1. 1. Compiled and edited by AJ
  2. 2. ①HISTORY • Abdominal pain – Site: upper abdomen – Acute onset – Gradually intensifies in severity – Duration: varies – Radiates to the back – Worsening when drinking alcohol or eating heavy meal – Relieve sometimes by sitting upright or leaning forward – Associated with nausea, vomiting, anorexia, fever
  3. 3. Don’t forget to ask.. • History of previous biliary colic • History of alcohol consumption • Any recent operative or other invasive procedures (e.g. ERCP) • Any intake of certain medications • Any viral infection • Family history of hypertriglyceridemia
  4. 4. ②EXAMINATION General examination • Pale • Diaphoretic • Listless • Jaundice (minority of patients) Vital signs • Fever • Tachycardia • Hypotension • Tachypnea
  5. 5. Abdominal examination • Abdominal tenderness • Muscular guarding (guarding tends to be more pronounced in the upper abdomen) and distention. • Bowel sounds are often diminished or absent because of gastric and transverse colonic ileus.
  6. 6. Uncommon physical findings • Cullen’s sign: bluish discoloration around the umbilicus resulting from hemoperitoneum • Grey-Turner’s sign : reddish- brown discoloration along the flanks resulting from retroperitoneal blood dissecting along tissue planes. • Erythematous skin nodules : focal subcutaneous fat necrosis(size not more than 1 cm, and the site is on extensor skin surfaces) • Polyarthritis
  7. 7. ③INVESTIGATIONS LABORATORY • CBC – Anemia(hgic), leukocytosis (inflammation, infection) • Liver enzymes – ALT if increases more that 150 U/L probably dto gallstones • Serum electrolytes, BUN, creatinine – Low Ca2+ • Blood glucose, cholesterol, triglycerides – Blood glucose high dto B-cell injury • ABG – respiratory distress
  8. 8. Laboratory studies Serum amylase Serum lipase C- reactive protein Other markers
  9. 9. • Pancreatic enzymes (serum amylase and lipase) – Serum amylase sensitivity of 81-95% but not specific for pancreatitis – Serum lipase more preferred dto its improved sensitivity esp in alcohol-induced pancreatitis, and its prolonged elevation – Rise 2-4 times the upper limit of normal is recommended for dx – Neither is useful in monitoring or predicting the severity the episode of acute pancreatitis
  10. 10. • Serum C-Reactive Protein: best marker for severity • Trypsinogen and elastase have no significant advantage over amylase or lipase
  11. 11. IMAGING IN ACUTE PANCREATITIS Role: • To clarify the diagnosis when the clinical picture is confusing • Help in determine the possible causes • Assess severity (Balthazar score) • Determine prognosis • Detecting complications
  12. 12. 1. Abdominal Ultrasound • Indicated early in acute pancreatitis – Pros • Inexpensive • Excellent for identifying gallbladder pathology • Technique of choice of detecting gallstones (Most common cause of pancreatitis!) • Evaluate bile‐duct dilation • May visualize masses and follow up of pseudocyst – Cons • Not optimal for pancreas; retroperitoneal location easily obscured by bowel gas distension • Less sensitive for stones in distal CBD • Limited in early assessment of pancreatitis
  13. 13. 2. Abdominal X-ray • Limited role in acute pancreatitis • Poor visualization of the pancreas and retroperitoneum • Most common radiologic signs associated with acute pancreatitis include: – Free air in the abdomen, indicating a perforated viscus – The colon cut-off sign, and sentinel loop sign, both indicating inflammatory process damaging peripancreatic structures
  14. 14. COLON CUT-OFF SIGN •Markedly distended transverse colon with air •Absence of gas distal to splenic flexure
  15. 15. SENTINEL LOOP SIGN Mildly dilated, gas-filled segment of small bowel with or without air fluid level
  16. 16. 3. Contrast-Enhanced CT • Standard imaging of choice – Pros • Aid in diagnosis and staging of pancreatitis • Evaluate complications • Evaluate common bile duct for stones or other obstructions • Assess severity of acute pancreatitis (CT Severity Index) – Cons • limited in patients who are allergic to intravenous (IV) contrast or have renal insufficiency.
  17. 17. CTSI
  18. 18. 3. MRI • Increasingly used in diagnosis and management of acute pancreatitis – Pros • alternative in situations in which CECT is contraindicated • Non‐invasive and no use of IV contrast • Ability to delineate pancreatic and bile ducts (detect choledocholithiasis missed on U/S ) • Greater sensitivity than CT in detecting mild pancreatitis – Cons • Expensive • Less readily available in non‐tertiary medical centers
  • RahulBaldaniyaRoyahi

    Feb. 3, 2021
  • ashishguragain2

    Jan. 13, 2019
  • prachisinghal737

    May. 2, 2018

of clinical, lab and imaging

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