True about acute pancreatitis
Correct Answer: CECT is preferred over USG in diagnosis
Description: Gall stones are the most common cause, alcohol being IInd most common. Ultrasound is often the first imaging investigation but CT is the best imaging investigation. Serum amylase is the most widely used laboratory test because of its simplicity. It lacks the specificity to pancreas and may be raised in a multitude of condition causing high false positive reactions. Moreover there can be cases of acute pancreatitis with normal serum amylase levels. Serum amylase level usually return to normal after 48 to 72 hrs of acute episode, fuher limiting its usefulness. Serum Lipase is now the single best enzyme to measure for the diagnosis of acute pancreatitis. Its level remains elevated for much longer duration of time (7 to 14 days) Other specific serum markers for acute pancreatitis are: - pancreatic isoamylase - trypsinogen One more fact about serum amylase is woh mentioning There is no significant correlation between the magnitude of serum amylase elevation and severity of pancreatitis, in fact, a milder form of acute pancreatitis is often associated with higher levels of serum amylase as compared with that in a more severe fonn of the disease. Surgical treatment is needed rarely in acute pancreatitis. The disease is self-limited in --85% to 90% of patients and subsides within 3-7 days. Surgical management is needed in cases of necrotic pancreatitis, pancreatic abscess and intervention in gall stone pancreatitis. Grey Turners sign is bluish discolouration seen at the flanks Bluish discolouration around the umbilicus is known as Cullen's sign. Mnemonic: GF Grey Turner's sign - Flanks Cullen's sign - Umbilicus Both of these signs indicate severe necrotizing pancreatitis. Ref : Harrison 17/e p2002 , Schwaz 9/e p1181
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