Abstract
The incidence and prevalence of acute pancreatitis (AP) is increasing over time. The diagnosis of acute pancreatitis is established by revised Atlanta criteria (2012). Multiple criteria and scoring systems have been used for assessment of severity of AP. Majority of acute pancreatitis cases (80%) are mild, the challenge remains in early diagnosis, severity assessment and treatment of severe AP and its complications. Assessment of severity of AP is important part of management because line of treatment depends on aetiology and severity of acute pancreatitis. In this article a comprehensive review of recent advances in diagnosis and severity assessment of acute pancreatitis has been described.
Highlights
Course of acute pancreatitis (AP) is highly heterogeneous and at risk for development of persistent organ failure early in the course of severe AP
To decrease the mortality rate of the severe acute pancreatitis, it is important to evaluate the severity of AP early in the disease course and initiate appropriate treatment according to severity and aetiology ( Juneja et al, 2010)
Others radiological index Several other scores such as pancreatic size index (PSI), mesenteric edema and peritoneal fluid (MOP) score, extrapancreatic (EP) score, extrapancreatic inflammation on CT (EPIC) score, and MR severity index (MRSI) have been evaluated but none of these radiological scoring system were shown to be superior to clinical scoring systems (Tang et al, 2011; Bollen et al, 2012)
Summary
Course of acute pancreatitis (AP) is highly heterogeneous and at risk for development of persistent organ failure early in the course of severe AP. Some medical and surgical conditions such as inflammatory bowel disease, renal insufficiency, appendicitis, intestinal ischemia, obstruction, perforation, acute cholecystitis may give false positive result (Matull et al, 2006; Lippi et al, 2012; Meher et al, 2015) Drug such as furosemide can increase serum lipase level (Matull et al, 2006). Several conditions increase serum amylase level such as macroamylasemia, renal failure, oesophageal perforation, mumps parotitis, pregnancy, chronic alcoholism, post coronary bypass, lactic acidosis, anorexia nervosa or bulimia (Pieper-Bigelow et al, 1990; Cappell, 2008). Critical acute AP: infected (peri) pancreatic necrosis and persistent organ failure
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