Emergency Medical Minute31 Okt 2018

Podcast #399: Hunting for pancreatitis

Author: Michael Hunt, MD

Educational Pearls:

Alcohol and gallstones are most common causes of pancreatitis
Diagnosis is not simply based on lipase alone - must have at least two the the three criteria:
- Elevated lipase (greater than 3x upper limit of reference range)
- Typical pain (epigastric pain, radiating to back, etc.)
- Radiographic findings suggestive of pancreatitis (CT, MRI, US)
BISAP criteria can help risk stratify mortality in pancreatitis. You get 1 point for each of the following:
- BNP > 25
- Impaired mental status
- SIRS criteria, more than 2
- AGE > 60
- Pleural effusion
BISAP score of 0 has < 1% mortality

Editor's note: The severity of pancreatitis does not correlate with serum lipase levels - notice how it is not used in the BISAP criteria, as an example. Even a mild elevation in serum testing can result in severe pancreatitis.

References:

Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS; Acute Pancreatitis Classification Working Group.. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11. doi: 10.1136/gutjnl-2012-302779. Epub 2012 Oct 25. PubMed PMID: 23100216.

Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC. Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis. Am J Gastroenterol. 2010 Feb;105(2):435-41; quiz 442. doi: 10.1038/ajg.2009.622. Epub 2009 Oct 27. PubMed PMID: 19861954.

Wu BU, Johannes RS, Sun X, Tabak Y, Conwell DL, Banks PA. The early prediction of mortality in acute pancreatitis: a large population-based study. Gut. 2008 Dec;57(12):1698-703. doi: 10.1136/gut.2008.152702. Epub 2008 Jun 2. PubMed PMID: 18519429.

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