P-P52 Overuse of CT scans in the diagnosis of Acute Pancreatitis

Abstract Background Acute pancreatitis is an acute inflammatory process affecting the pancreas with variable involvement of local tissues and remote organs and may sometimes progress into necrosis of the pancreas. Diagnosis is usually made based on the clinical presentation of abdominal pain alongside a positive biochemical result of either serum amylase or lipase levels. Current guidelines by International Association of Pancreatology (IAP) state that early use of computed tomography (CT) is only indicated in patients who have no definite diagnosis, and should be delayed to at least 96 hours after the onset of the symptoms to evaluate complications. We aimed to assess the over-utilization of CT scans in the diagnosis of acute pancreatitis. Methods We performed a prospective cohort study of patients with confirmed acute pancreatitis who presented to a single NHS trust between March and April 2021. We included patients with at least two out of the three findings: (1) an acute abdominal pain, (2) elevated serum amylase levels of more than three times the normal range and (3) acute pancreatitis as evidenced on abdominal imaging. We defined inappropriate CT scans as those performed within 96 hours in the presence of both clinical and biochemical diagnostic criteria. Results A total of 53 patients met the inclusion criteria and were admitted with acute pancreatitis during this 2-month period at our trust. 54.7% (29/53) of this cohort had at least one CT scan performed during the index admission. 28.3% (15/53) of the admitted patients had an early CT scan performed in the presence of positive biochemical and clinical diagnostic criteria. This represents 51.7% of the total number of CT scans performed in the study group. Conclusions We found evidence of excessive use of CT scans in the early phase of acute pancreatitis for diagnostic purposes. Limiting the overuse of CT scans in the diagnosis of the same will not just reduce the financial burden of the hospital and trust, but also limit the avoidable exposure of patients to radiation.

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Clinical Profile of Acute Pancreatitis in Children in a Tertiary Level Hospital of Bangladesh

Bangladesh Journal of Child Health ◽

10.3329/bjch.v40i3.33057 ◽

2017 ◽

Vol 40 (3) ◽

pp. 160-165

Author(s):

Nadira Musabbir ◽

ASM Bazlul Karim ◽

Md Wahiduzzaman Mazumder ◽

Kaniz Sultana ◽

Syeda Afria Anwar ◽

...

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Serum Amylase ◽

Abdominal Mass ◽

Elevated Serum ◽

Clinical Feature ◽

Cross Sectional ◽

Female Ratio ◽

Epigastric Region ◽

Common Location

Background: Acute pancreatitis is an acute inflammatory condition of the pancreas that may extend to local and distant extrapancreatic tissues. The incidence of acute pancreatitis in children has increased significantly in the past two decades. It can be associated with severe morbidity and mortality. It should be considered in every child with unexplained acute abdominal pain.Objectives: To observe the clinical, biochemical and imaging profiles of acute pancreatitis in children.Methods: It was a cross-sectional study conducted at the Department of Pediatric Gastroenterology & Nutrition of Bangabandhu Sheikh Mujib Medical University, Dhaka from January 2014 through June 2015. A total of 50 cases of acute pancreatitis were included in this study. The diagnosis of acute pancreatitis was based on diagnostic criteria of acute pancreatitis made by INSPPIRE group (If a child had any 2 of the 3 criteria: the abdominal pain compatible with acute pancreatitis, elevated serum amylase and /or lipase level more than three times of upper limit of normal, imaging findings compatible with acute pancreatitis). Clinical characteristics, laboratory and imaging profile of the cases, complications were studied.Results: Among 50 cases, male were 46% and male female ratio was 0.8:1. Mean age at presentation was 10.2 ± 3.2 years. Forty eight (96%) patients had abdominal pain which was severe agonizing in 81.3% cases. The common location of pain was in epigastric region (77%). Pain radiating to back in 22.9% patients. Mean duration of pain was 6.6 ± 4.4 days before hospital admission. Vomiting was present in 72% patients followed by fever (30%). Two (4%) patients had jaundice. Ascites was noted in 12% patients and abdominal mass in 6% patients. Out of 50 cases of AP, biliary sludge was associated in 6% patients, biliary ascariasis in 4%, choledochal cyst in 2% and gallbladder stone in 2% patients. But in this study, 4% patients had Wilson disease. Laboratory tests showed leukocytosis in 28% patients, high serum amylase and lipase level in 56% and 58% patients respectively. Postive findings in ultrasonogram were present in 66% patients. In the present study, hypocalcemia was found in 38% patients, pseudocyst in 6% and pancreatic necrosis in 2% patients.Conclusion: Although acute pancreatitis may present with varieties of clinical feature, the most common one is abdominal pain and common location of pain is in epigastric region. For confirmation of clinically diagnosed pancreatitis, both serum amylase and lipase level and abdominal ultrasound are useful tools.Bangladesh J Child Health 2016; VOL 40 (3) :160-165

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Elevated Amylase Levels as a Result of Self-Induced Hypersalivation

PEDIATRICS ◽

10.1542/peds.71.4.585 ◽

1983 ◽

Vol 71 (4) ◽

pp. 585-587

Author(s):

Jacques Belik ◽

Carl Tishler ◽

Juhling McClung

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Pediatric Patients ◽

Serum Amylase ◽

Amylase Activity ◽

Elevated Serum ◽

Pancreatic Disease ◽

Sensitive Indicator ◽

Recurrent Vomiting ◽

Serum Amylase Activity

A patient with recurrent vomiting, abdominal pain, and elevated serum amylase activity may have pancreatitis. Although elevated serum amylase levels are a sensitive indicator for acute pancreatitis, this test is not highly specific for pancreatic disease. A patient is described who illustrates the need for specific laboratory, historical, and occasional psychological evaluation in pediatric patients with elevated amylase values.

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ACUTE PANCREATITIS: AS A REASON FOR PRETERM DELIVERY

10.36106/gjra/2817815 ◽

2021 ◽

pp. 277-278

Author(s):

Muzeyyen Uyanik ◽

Deniz Simsek

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Gall Bladder ◽

Hospital Stay ◽

Preterm Delivery ◽

Serum Amylase ◽

Elevated Serum ◽

Oral Intake ◽

Well Being ◽

Gestational Week

Acute pancreatitis which is the rare reason for acute abdomen during pregnancy could cause morbidity or mortality. Physiologic changes of pregnancy affect the gall bladder and bile ingredients which play a crucial role in acute pancreatitis. Damage in the pancreas initiates local inammation and damage in the pancreas however, systemic inammatory response and multi-organ dysfunction are not rare. Additionally, acute pancreatitis during pregnancy could be a reason for preterm delivery as we aimed to present two cases in the last trimester of the pregnancy. Case 1: rd A 19-year-old woman in her 33 gestational week of pregnancy was admitted to the emergency room with acute abdominal pain and vomiting for 4 hours. She had a rm cervix on vaginal examination and ultrasonographic evaluation revealed a live fetus with a 2620 gr of estimated fetal weight, normal amniotic uid index, and placenta. Laboratory tests presented as elevated serum amylase and lipase. A hydropic gallbladder with multiple gall stones was detected in the abdominal ultrasound. The patient was hospitalized with an acute pancreatitis diagnosis. During the hospital stay, uterine th contractions had initiated and cervical dilation has progressed. The patient was delivered a live baby and discharged on the 7 hospital stay. She was performed laparoscopic cholecystectomy 4 weeks after the delivery. Case 2: th A 28-year-old woman in her 35 gestational week was admitted to the emergency department with right upper quadrant pain. Abdominal and obstetric ultrasounds were uneventful. Laboratory examination revealed an elevated serum amylase and lipase. She was hospitalized. During the hospital stay; despite the medical treatments and prevention of oral intake, the levels of amylase and lipase and the abdominal pain have progressed. The patient was delivered via cesarean section. The levels of amylase and lipase decreased progressively, and the upper quadrant abdominal pain gradually decreased. The patient was discharged on day 7. Discussion: Acute pancreatitis could cause a systemic inammatory response which could lead to preterm delivery. Upper abdominal pain is the essential symptom and elevated serum amylase and lipase about 3-fold are the most common nding. Ultrasonographic evaluation of the gall-bladder and pancreas is crucial. Magnetic resonance cholangiopancreatography without contrast medium can also be used for diagnosis. A multidisciplinary approach is essential for treatment and follow-up. Obstetricians should evaluate fetal well being, and consider acute pancreatitis as a reason for threatened preterm labor.

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A case of acute pancreatitis with normal serum amylase and lipase value

10.52768/jjgastro/1006 ◽

2021 ◽

Vol 1 (2) ◽

Author(s):

Jayanta Paul ◽

Keyword(s):

Acute Pancreatitis ◽

Ct Scan ◽

Acute Pain ◽

Serum Amylase ◽

Elevated Serum ◽

Serum Triglyceride ◽

Normal Serum ◽

Upper Limit ◽

Pain Abdomen ◽

Rule Out

There are several causes of acute pancreatitis (AP). In clinical practice, AP is diagnosed by presence of acute pain abdomen, elevated serum amylase and lipase value (>3 times of upper limit of normal) and ultrasonographic (USG) findings of acute pancreatitis but in only 25-50% of patients with acute pancreatitis, pancreas is visualised. In this case, 44 years gentleman was presented with acute pain abdomen, normal serum amylase and lipase value and no pancreatic abnormality in abdominal USG. After diagnosis of elevated serum triglyceride, computed tomography (CT scan) of abdomen was done to exclude hypertriglyceridemia induced AP. CT scan abdomen showed features of acute pancreatitis. Therefore, in every patient with acute pain abdomen if serum amylase and lipase value and USG abdomen are normal, serum triglyceride should be advised to rule out hypertriglyceridemia induced AP. In this case report we are going to present a case of acute pancreatitis with normal serum amylase and lipase value.

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Acute pancreatitis

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.152401_update_001 ◽

2010 ◽

pp. 2557-2567

Author(s):

R. Carter ◽

C.J. McKay

Keyword(s):

Acute Pancreatitis ◽

Peptic Ulcer ◽

Gastric Ulcer ◽

Abdominal Pain ◽

Serum Amylase ◽

Perforated Peptic Ulcer ◽

Upper Limit ◽

Abdominal Emergencies ◽

Idiopathic Acute Pancreatitis ◽

Upper Abdominal

Acute pancreatitis affects 300 to 600 new patients per million population per year and is most commonly caused by gallstones or alcohol, but there are many other causes and associations. Careful imaging reveals that most so-called idiopathic acute pancreatitis is due to small (1–3 mm diameter) gallstones. Diagnosis is made by a combination of a typical presentation (upper abdominal pain and vomiting) in conjunction with raised serum amylase (> × 3 upper limit of normal) and/or lipase (> × 2 upper limit of normal). Several acute abdominal emergencies can mimic acute pancreatitis and may be associated with a raised serum amylase. These include perforated peptic ulcer (particularly perforated posterior gastric ulcer) and acute mesenteric ischaemia. In equivocal cases, a CT scan is indicated in order to exclude other causes and confirm the diagnosis....

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Use of CT Scans for Abdominal Pain in the ED: Factors in Choice

The American Surgeon ◽

10.1177/000313482008600428 ◽

2020 ◽

Vol 86 (4) ◽

pp. 324-333 ◽

Cited By ~ 1

Author(s):

Aubrey A. Mwinyogle ◽

Astha Bhatt ◽

Onyebuchi U. Ogbuagu ◽

Neer Dhillon ◽

Anne Sill ◽

...

Keyword(s):

Abdominal Pain ◽

Ct Scan ◽

Primary Diagnosis ◽

Socioeconomic Disparities ◽

Ct Scans ◽

Utilization Rate ◽

Rebound Tenderness ◽

High Index Of Suspicion ◽

Ct Finding

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CTis a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers’ decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CTscan and the acuity of CTscan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged <60 years. There is a need for committed efforts to optimize CT scan utilization and eliminate socioeconomic disparities in health care.

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Acute Pancreatitis with Rapid Clinical Improvement in a Child with Isovaleric Acidemia

Case Reports in Pediatrics ◽

10.1155/2013/721871 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Elpis Mantadakis ◽

Ioannis Chrysafis ◽

Emmanouela Tsouvala ◽

Athanassios Evangeliou ◽

Athanassios Chatzimichael

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Acute Abdominal Pain ◽

Elevated Serum ◽

Unknown Origin ◽

Organic Acidemia ◽

Abdominal Ultrasonography ◽

Isovaleric Acidemia ◽

Intravenous Hydration ◽

Branched Chain

Isovaleric acidemia is a rare branched-chain organic acidemia. The authors describe a 3.5-year-old girl with isovaleric acidemia and acute abdominal pain associated with bilious emesis. Elevated serum amylase and abdominal ultrasonography demonstrating an enlarged and edematous pancreas, along with the presence of peripancreatic exudates, confirmed the presence of acute pancreatitis. The patient recovered quickly with intravenous hydration, pancreatic rest, and administration of intravenous L-carnitine. Pancreatitis should be ruled out in the context of vomiting in any patient with isovaleric acidemia. Conversely, branched-chain organic acidemias should be included in the differential diagnosis of any child with pancreatitis of unknown origin.

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Hypothermia and Acute Pancreatitis: Myth or Reality?

Journal of the Royal Society of Medicine ◽

10.1177/014107680309600506 ◽

2003 ◽

Vol 96 (5) ◽

pp. 228-229 ◽

Cited By ~ 5

Author(s):

Rh E Stiff ◽

Gj Morris-Stiff ◽

J Torkington

Keyword(s):

Acute Pancreatitis ◽

Risk Factor ◽

Abdominal Pain ◽

Dual Diagnosis ◽

Cerebrovascular Accident ◽

Serum Amylase ◽

Response Rate ◽

Emergency Admissions ◽

Weak Evidence ◽

Relevant Risk Factor

Among the rarer causes of acute pancreatitis listed in surgical texts is hypothermia. To assess the evidence for cause and effect, we questioned selected consultants about their experience and examined the case-notes of patients admitted with hypothermia. The 31 consultants who returned our questionnaire (69% response rate; 317 consultant-years’ experience) could recall only 5 cases of pancreatitis associated with hypothermia, in 2 of which other aetiological factors were judged primary. In case-notes for 100 months of emergency admissions at a single hospital we identified 310 patients with hypothermia and 1153 with acute pancreatitis; none had the dual diagnosis. Of the hypothermic patients, none had abdominal pain typical of acute pancreatitis. In 43 serum amylase was measured because the patient was unable to give a full history and in 2 of these the enzyme was slightly raised; both had experienced a cerebrovascular accident, which is a known cause of hyperamylasaemia. Considered alongside the weak evidence from previous studies, these findings offer negligible support for the idea that hypothermia is a clinically relevant risk factor for acute pancreatitis.

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Man with epigastric pain and persistently elevated serum lipase

BMJ Case Reports ◽

10.1136/bcr-2019-229208 ◽

2019 ◽

Vol 12 (4) ◽

pp. e229208

Author(s):

Caroline Annette Erika Bachmeier ◽

Adam Morton

Keyword(s):

Acute Pancreatitis ◽

Abdominal Pain ◽

Epigastric Pain ◽

Elevated Serum ◽

Pancreatic Disease ◽

Radiological Assessment ◽

Serum Lipase ◽

Persistent Elevation ◽

Assay Interference ◽

Laboratory Assay

Serum lipase and amylase are commonly requested in individuals presenting with abdominal pain for investigation of acute pancreatitis. Pancreatic hyperenzymaemia is not specific for acute pancreatitis, occurring in many other pancreatic and non-pancreatic conditions. Where persistent elevation of serum lipase and amylase occurs in the absence of a diagnosed cause or evidence of laboratory assay interference, ongoing radiological assessment for pancreatic disease is required for 24 months before a diagnosis of benign pancreatic hyperenzymaemia can be made. We report a case of a 71-year-old man with epigastric pain and elevated serum lipase levels. He was extensively investigated, but no pancreatic disease was detected. He is asymptomatic, but serum lipase levels remain elevated 18 months after his initial presentation.

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Abdominal pain and a raised amylase? It’s not always pancreatitis…

Acute Medicine Journal ◽

10.52964/amja.0310 ◽

2013 ◽

Vol 12 (3) ◽

pp. 163-165

Author(s):

IO Oluwatowoju ◽

◽

EO Abu ◽

G Lawson ◽

◽

...

Keyword(s):

Acute Pancreatitis ◽

Serum Amylase ◽

Epigastric Pain ◽

Elevated Serum ◽

High Serum ◽

Amylase Level ◽

Serum Amylase Level ◽

Heavy Alcohol ◽

Heavy Alcohol Consumption ◽

History Of

We report the case of a 72 year old man with a history of COPD and heavy alcohol consumption who was initially diagnosed with acute pancreatitis based on a presentation with epigastric pain and elevated serum amylase. Review of his notes revealed several previous similar admissions and extensive normal investigations apart from persistently elevated amylase. Further analysis showed evidence of macroamylasaemia which accounted for the apparently high serum amylase level.

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