Investigations:

serum amylase (>1000u/ml or 3x of upper limit): levels start falling in 24-48hrs
raised serum lipase (specific to pancreas)
FBC, U&E, glucose (hyperglycaemic) and CRP : CRP>150 indicates severe disease, may be reduced in drug-induced cases
ABG: monitor O2 and acid-base levels
Raised bilirubin and/or serum aminotransferase suggest gallstones.
Hypocalcaemia is relatively common.
Abdominal X-ray: excludes some other causes (eg, intestinal obstruction and perforation) and may show calcification.
CXR may show elevation of one hemidiaphragh
m, infiltrates ± acute respiratory distress syndrome (ARDS) or pleural effusions in severe cases.
CT scan with contrast enhancement may be diagnostic where clinical and biochemical results are equivocal on admission. CT after four days can help in the assessment of complications.
Contrast-enhanced CT scanning can identify pancreatic swelling, fluid collection and change in density of gland.
Ultrasound: The pancreas is poorly visualised in 25-50% of cases.
Ultrasound can show a swollen pancreas, dilated common bile duct and free peritoneal fluid.It is useful to detect the presence of gallstones.
MRI may reveal acute abdominal wall oedema which may be a supplementary indicator of severity

	Created by bessimajamal almost 10 years ago

Note on Pancreas, created by bessimajamal on 14/06/2014.

Pancreas