see: [Atlas of Emergency Radiology - Pancreatitis](x-devonthink-item://B6184854-F3D2-4BE0-A504-1FC8656F4BD8?page=342), [Paediatric pancreatitis](x-devonthink-item://763D1D4B-792A-47C2-BB50-EA84BA03F1F3?page=283) see: [[Lipase]] **Diagnosis** - [[Lipase]] ≥ 3x upper limit of normal - characteristic abdominal pain - characteristic CT or ultrasound findings > note: significant elevations in lipase are found only during acute attacks of pancreatitis. in the later stages of *chronic pancreatitis*, atrophy of pancreatic parenchyma can result in serum enzyme levels within normal range, even during acute attacks of pain. ∴ lipase is not helpful in making a diagnosis of "acute on chronic" pancreatitis; this is usually a clinical diagnosis. > - pancreatic calcifications may be seen on abdo XR, may see in CT. [[ERCP vs. MRCP|ERCP]] best visualisation for diagnosis chronic pancreatitis. **causes** - [[Alcohol-related disease|EtOH]] - gallstones - post ERCP - idiopathic - HLD - DM2 - [[hypercalcaemia|hypercalcemia]] - trauma to abdomen - drugs - sulpha, thiazides, steroids - vasculitis - mumps GET SMASHED gallstones, ethanol, trauma, steroids, mumps, autoimmune, Silly scorpion, hyperlipidemia and hypercalcemia, ERCP, drugs **Ranson's criteria** - age >55 - glucose >10 - WCC >16k - LDH >350 - ALT >250 **complications** - [[ARDS]] - pleural effusions - third spacing and hypovolaemia - acute tubular necrosis - pancreatic pseudo cysts - can cause infection - erosion into blood vessel → haemorrhage - biliar or pyloric obstruction - expanding or symptomatic cysts drained ; <6cm usually respond spontaneously - pancreatic haemorrhage - [[Hypocalcemia]] - [[hyperglycaemia|hyperglycemia]] - *splenic or portal vein thrombosis* - chronic pancreatitis in ~10% - diabetes - [[DIC]] - [[Acute Renal Failure|AKI]] > note: infection, portal vein thrombosis, and pseudocyst are *late* complications of pancreatitis # CT examples #radiology ## normal pancreas ![[Pasted image 20241105233832.png]] body of pancreas (thick white arrow) and splenic artery (thin white arrow). adrenal glands are doted white arrows. GB black arrow. ## abi-normal pancreas ![[Pasted image 20241105232853.png|diffuse pancreatic enlargement and peripancreatic oedema. the pancreatic parenchyma enhances uniformly, without evidence for necrosis]] ![[Pasted image 20241105232939.png|pancreatic oedema and enlargement, hetrogenous appearance suggesting necrosis, peripancreatic fat stranding, significant peritoneal free fluid]]