Case Report
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Year 2019, Volume: 10 Issue: 4, 118 - 120, 01.10.2019
https://doi.org/10.33706/jemcr.566729

Abstract

References

  • REFERENCES1. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 1993;128:586-90.
  • REFERENCES2. Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician 2007;75:1513-20.
  • REFERENCES3. Demirci H, Polat Z, Kantarcıoğlu M, Öztürk K, Sakin YS, Uygun A, Bağcı S. An Atypical Presentation in Acute Pancreatitis: Normal Amylase Level. Ankara Med J, 2014, 14 (Annex 1): 1 – 2
  • REFERENCES4.Al- Bahrani AZ, Ammori BJ. Clinical laboratory assessment of acute pancreatitis. Clinica Chimica Acta 2005; 362:26-48.
  • REFERENCES5. Byrne MF, Mitchell RM, Stiffler H, Jowell PS, Branch MS, Pappas TN, et al. Extensive investigation of patients with mild elevations of serum amylase and/or lipase is “low yield”. Can J Gastroenterol 2002;16: 849-54.
  • REFERENCES6. Lillemoe KD, Yeo CJ, Management of complications of pancreatitis. Current Problems in Surgery, 1 (1): 1- 98, 1998.
  • REFERENCES7. Levant JA, Secrist DM, Resin H, et al. Nasogastric suction in the treatment of alcoholic pancreatitis: a controlled study. JAMA 229: 51, 1974.
  • REFERENCES8. Tamer et al. Evaluation of Acute Pancreatitis Sakaryamj;2011(1):17-21
  • REFERENCES9. Mitchell RM, Byrne MF, Baillie J. Pancreatitis.Lancet 2003; 361: 1447-55.
  • REFERENCES10. Koizumi M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006; 13:25-32.
  • REFERENCES11. Vissers RJ, Abu-Laban RB. Acute and chronic pancreatitis. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds.), Emergency medicine. A comprehensive study guide. 5th edition, New York: McGraw-Hill, 2000: 588-592.
  • REFERENCES12. Pekmezci S. Approach and Treatment in Acute Pancreatitis. I.U. Cerrahpasa faculty of Medicine, Continuous Medical Training Activities Hepato-Biliary System and Pancreatic Diseases Symposium Series No: January, 28, 2002; p. 239-262
  • REFERENCES13. Agarwal N, Pitchumoni CS, Sivaprasad AV. Evaluating tests for acute pancreatitis. Am J Gastroenterol. 1990;85(4):356.

Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?

Year 2019, Volume: 10 Issue: 4, 118 - 120, 01.10.2019
https://doi.org/10.33706/jemcr.566729

Abstract

Introduction:

Acute pancreatitis (AP); It is defined as a reversible
inflammatory process in which the tissue of the pancreas is affected at various
degrees, accompanied by local tissue or organ systems. It is characterized by a
sudden onset of upper abdominal pain and associated vomiting, fever,
tachycardia, leukocytosis, serum amylase or lipase increase of 3 times normal.
Acute pancreatitis has a spectrum of varying severity of disease ranging from
self-limiting mild disease that is present with abdominal pain to severe fluid
loss, metabolic imbalances, hypotension, sepsis and severe disease that may
lead to death. Mortality rate is 6-23% for acute pancreatitis in different
article.  We report the case with a
diagnosis of acute pancreatitis, who have abdominal pain; but no serum amylase
and lipase elevation. We diagnosed edematous pancreatitis image in the computed
tomography.

Case:

A 51-year-old male admitted to the emergency department with
sever abdominal pain. He had diabetes mellitus in his medical history; but
drugs used for DM could not be learned due to communicative reasons.
On
his presentation to our ED, he was conscious, oriented and cooperative. His
vital signs were as follows: his blood pressure was 130/90 mm Hg, his pulse
rate was 100 beats per min, his respiratory rate was 20 per min, his body
temperature was 36.5°C, and his oxygen saturation was 100% while breathing room
air. He has epigastric tenderness and abdominal guarding on palpation; but no
rebound tenderness or rigitidy was noted on palpation. No
pathological findings were found in the respiratory system, cardiovascular
system and neurological examination. The blood test measurements were
WBC:
5.50 10³/uL, Hb:13.2 g/dl, Plt:160.000 10³/uL, Glucose: 444  mg/dl, urea:30.0 mg/dl, serum creatinine:
0.74 mg/dL, AST: 13U/L,,ALT: 15 U/L, GGT:33 U/L, ALP: 107 U/L, Amylase: 28:
U/L, Lipase: 58.8 U/L, CRP: 104.05 mg/L, cardiac  troponine: 0.006 ng/ml. . ECG is normal beat.
In abdominal ultrasonography of
the patient; pancreas and midline structures could not be evaluated due to gas.
No ultrasonographic pathology was detected
in other intraabdominal organs and intraabdominal fluid was not seen in the abdominal ultrasonography. Contrast-enhanced computed
tomography (CT) of the abdomen was performed because of persistant, severe
abdominal pain and it revealed
peripancreatic diffuse inflammatory densities
(edematous pancreatitis), shown in image 1. The patient was consulted with the
internal medicine clinic.  Internal
Diseases Clinic suggested hydration with intravenous Serum Physiological and
then re-consultation with blood tests. We detected that 
WBC: 5.75 10³/uL, Hb:13 g/dl, Plt:150.000
10³/uL, Glukose: 248  mg/dl, urea:18.0
mg/dl, serum creatinine:
0.6 mg/dL, AST: 12U/L,,ALT: 14 U/L, GGT:31 U/L, ALP: 96 U/L, Amylase: 20: U/L,
Lipase: 38.1 U/L, CRP: 120.56 mg/L
cardiac 
troponine: 0.006 ng/ml in
blood test after hydration.

The patient was re-consulted with
the internal medicine clinic.
Internal
Diseases Clinic suggested hospitalization with the diagnosis of edematous
pancreatitis to him.

Discussion:

Patients with acute pancreatitis are admitted to the emergency department with abdominal pain, nausea and vomiting. Generally, the amylase and lipase elevation are seen in the blood tests and then abdominal computed tomography is performed for further examination and follow-up. 
When amylase and lipase are detected in normal values, pancreatitis is not thought; but Two of the three criteria for acute pancreatitis must be determined. These criteria are abdominal pain, amylase-lipase elevation and view compatible with pancreatitis in imaging examinations. In this context, a rare diagnosis of pancreatitis can be made without amylase and  lipase elevation. In our case, the patient was diagnosed with pancreatitis because of having abdominal pain and imaging consistent with pancreatitis without elevated amylase and lypase.

Conclusion: 











As in this case, blood tests are not sufficient for diagnosis of pancreatitis and if there is clinical necessity, the emergency physician should consider imaging examinations for diagnosis of pancreatitis.

References

  • REFERENCES1. Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg 1993;128:586-90.
  • REFERENCES2. Carroll JK, Herrick B, Gipson T, Lee SP. Acute pancreatitis: diagnosis, prognosis, and treatment. Am Fam Physician 2007;75:1513-20.
  • REFERENCES3. Demirci H, Polat Z, Kantarcıoğlu M, Öztürk K, Sakin YS, Uygun A, Bağcı S. An Atypical Presentation in Acute Pancreatitis: Normal Amylase Level. Ankara Med J, 2014, 14 (Annex 1): 1 – 2
  • REFERENCES4.Al- Bahrani AZ, Ammori BJ. Clinical laboratory assessment of acute pancreatitis. Clinica Chimica Acta 2005; 362:26-48.
  • REFERENCES5. Byrne MF, Mitchell RM, Stiffler H, Jowell PS, Branch MS, Pappas TN, et al. Extensive investigation of patients with mild elevations of serum amylase and/or lipase is “low yield”. Can J Gastroenterol 2002;16: 849-54.
  • REFERENCES6. Lillemoe KD, Yeo CJ, Management of complications of pancreatitis. Current Problems in Surgery, 1 (1): 1- 98, 1998.
  • REFERENCES7. Levant JA, Secrist DM, Resin H, et al. Nasogastric suction in the treatment of alcoholic pancreatitis: a controlled study. JAMA 229: 51, 1974.
  • REFERENCES8. Tamer et al. Evaluation of Acute Pancreatitis Sakaryamj;2011(1):17-21
  • REFERENCES9. Mitchell RM, Byrne MF, Baillie J. Pancreatitis.Lancet 2003; 361: 1447-55.
  • REFERENCES10. Koizumi M, Takada T, Kawarada Y, Hirata K, Mayumi T, Yoshida M, et al. JPN Guidelines for the management of acute pancreatitis: diagnostic criteria for acute pancreatitis. J Hepatobiliary Pancreat Surg. 2006; 13:25-32.
  • REFERENCES11. Vissers RJ, Abu-Laban RB. Acute and chronic pancreatitis. In: Tintinalli JE, Kelen GD, Stapczynski JS (eds.), Emergency medicine. A comprehensive study guide. 5th edition, New York: McGraw-Hill, 2000: 588-592.
  • REFERENCES12. Pekmezci S. Approach and Treatment in Acute Pancreatitis. I.U. Cerrahpasa faculty of Medicine, Continuous Medical Training Activities Hepato-Biliary System and Pancreatic Diseases Symposium Series No: January, 28, 2002; p. 239-262
  • REFERENCES13. Agarwal N, Pitchumoni CS, Sivaprasad AV. Evaluating tests for acute pancreatitis. Am J Gastroenterol. 1990;85(4):356.
There are 13 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Report
Authors

Cesareddin Dikmetaş 0000-0002-3203-2029

Başar Cander 0000-0002-3308-5843

Bensu Bulut 0000-0002-5629-3143

Dilek Atik This is me 0000-0002-3270-8711

Ayla Köksal This is me 0000-0003-2975-2743

Ramazan Güven 0000-0003-4129-8985

Publication Date October 1, 2019
Submission Date June 12, 2019
Published in Issue Year 2019 Volume: 10 Issue: 4

Cite

APA Dikmetaş, C., Cander, B., Bulut, B., Atik, D., et al. (2019). Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?. Journal of Emergency Medicine Case Reports, 10(4), 118-120. https://doi.org/10.33706/jemcr.566729
AMA Dikmetaş C, Cander B, Bulut B, Atik D, Köksal A, Güven R. Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?. Journal of Emergency Medicine Case Reports. October 2019;10(4):118-120. doi:10.33706/jemcr.566729
Chicago Dikmetaş, Cesareddin, Başar Cander, Bensu Bulut, Dilek Atik, Ayla Köksal, and Ramazan Güven. “Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?”. Journal of Emergency Medicine Case Reports 10, no. 4 (October 2019): 118-20. https://doi.org/10.33706/jemcr.566729.
EndNote Dikmetaş C, Cander B, Bulut B, Atik D, Köksal A, Güven R (October 1, 2019) Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?. Journal of Emergency Medicine Case Reports 10 4 118–120.
IEEE C. Dikmetaş, B. Cander, B. Bulut, D. Atik, A. Köksal, and R. Güven, “Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?”, Journal of Emergency Medicine Case Reports, vol. 10, no. 4, pp. 118–120, 2019, doi: 10.33706/jemcr.566729.
ISNAD Dikmetaş, Cesareddin et al. “Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?”. Journal of Emergency Medicine Case Reports 10/4 (October 2019), 118-120. https://doi.org/10.33706/jemcr.566729.
JAMA Dikmetaş C, Cander B, Bulut B, Atik D, Köksal A, Güven R. Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?. Journal of Emergency Medicine Case Reports. 2019;10:118–120.
MLA Dikmetaş, Cesareddin et al. “Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?”. Journal of Emergency Medicine Case Reports, vol. 10, no. 4, 2019, pp. 118-20, doi:10.33706/jemcr.566729.
Vancouver Dikmetaş C, Cander B, Bulut B, Atik D, Köksal A, Güven R. Which One Is More Important For The Diagnosis Of Acute Pancreatitis? Blood Tests Or Imaging?. Journal of Emergency Medicine Case Reports. 2019;10(4):118-20.