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Acute Pancreatitis

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Kazunori Takeda – One of the best experts on this subject based on the ideXlab platform.

  • Gallstone-induced Acute Pancreatitis.
    Journal of hepato-biliary-pancreatic sciences, 2009
    Co-Authors: Yasutoshi Kimura, Kazunori Takeda, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Shinju Arata, Toshifumi Gabata, Hodaka Amano
    Abstract:

    In the care of Acute Pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced Acute Pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced Acute Pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced Acute Pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced Pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced Acute Pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

  • JPN Guidelines for the management of Acute Pancreatitis: diagnostic criteria for Acute Pancreatitis
    Journal of hepato-biliary-pancreatic surgery, 2006
    Co-Authors: Masaru Koizumi, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Miho Sekimoto, Masahiko Hirota, Yasutoshi Kimura, Kazunori Takeda
    Abstract:

    The currently used diagnostic criteria for Acute Pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) Acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with Acute Pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and Acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of Acute Pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations: Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of Acute Pancreatitis and its differentiation from other diseases. A pivotal factor in the diagnosis of Acute Pancreatitis is identifying an increase in pancreatic enzymes in the blood. Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected Acute Pancreatitis. Magnetic resoresonanceging (MRI) is one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraperitoneal complications. Computed tomography (CT) is also one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of Acute Pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the Pancreatitis is unknown. When Acute Pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by Acute Pancreatitis are present. Because the etiology of Acute Pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced Acute Pancreatitis, which requires treatment of the biliary system, and alcohol-induced Acute Pancreatitis, which requires a different form of treatment.

  • JPN Guidelines for the management of Acute Pancreatitis: medical management of Acute Pancreatitis.
    Journal of hepato-biliary-pancreatic surgery, 2006
    Co-Authors: Kazunori Takeda, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Miho Sekimoto, Masahiko Hirota, Yasutoshi Kimura, Shuji Isaji
    Abstract:

    The basic principles of the initial management of Acute Pancreatitis are adequate monitoring of vital signs, fluid replacement, correction of any electrolyte imbalance, nutritional support, and the prevention of local and systemic complications. Patients with severe Acute Pancreatitis should be transferred to a medical facility where adequate monitoring and intensive medical care are available. Strict cardiovascular and respiratory monitoring is mandatory for maintaining the cardiopulmonary system in patients with severe Acute Pancreatitis. Maximum fluid replacement is needed to stabilize the cardiovascular system. Prophylactic antibiotic administration is recommended to prevent infectious complications in patients with necrotizing Pancreatitis. Although the efficacy of the intravenous administration of protease inhibitors is still a matter of controversy, there is a consensus in Japan that a large dose of a synthetic protease inhibitor should be given to patients with severe Acute Pancreatitis in order to prevent organ failure and other complications. Enteral feeding is superior to parenteral nutrition when it comes to the nutritional support of patients with severe Acute Pancreatitis. The JPN Guidelines recommend, as optional measures, blood purification therapy and continuous regional arterial infusion of a protease inhibitor and antibiotics, depending on the patient’s condition.

Masahiko Hirota – One of the best experts on this subject based on the ideXlab platform.

  • New diagnostic criteria of Acute Pancreatitis
    Journal of Hepato-Biliary-Pancreatic Sciences, 2010
    Co-Authors: Seiki Kiriyama, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Toshifumi Gabata, Masumi Kadoya, Eigoro Yamanouchi, Takayuki Hattori
    Abstract:

    Practical guidelines for the diagnosis of Acute Pancreatitis are presented so that a rapid and adequate diagnosis can be made. When Acute Pancreatitis is suspected in patients with Acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of Acute Pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other Acute abdominal diseases are ruled out if local findings associated with Pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having Acute Pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting Acute Pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of Acute Pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than Pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of Acute Pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of Acute Pancreatitis. Elucidation of the etiology of Acute Pancreatitis should be continued after a diagnosis of Acute Pancreatitis. In the process of the etiologic elucidation of Acute Pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced Acute Pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US.

  • Gallstone-induced Acute Pancreatitis.
    Journal of hepato-biliary-pancreatic sciences, 2009
    Co-Authors: Yasutoshi Kimura, Kazunori Takeda, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Shinju Arata, Toshifumi Gabata, Hodaka Amano
    Abstract:

    In the care of Acute Pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced Acute Pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced Acute Pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced Acute Pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced Pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced Acute Pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

  • JPN Guidelines for the management of Acute Pancreatitis: diagnostic criteria for Acute Pancreatitis
    Journal of hepato-biliary-pancreatic surgery, 2006
    Co-Authors: Masaru Koizumi, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Miho Sekimoto, Masahiko Hirota, Yasutoshi Kimura, Kazunori Takeda
    Abstract:

    The currently used diagnostic criteria for Acute Pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) Acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with Acute Pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and Acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of Acute Pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations: Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of Acute Pancreatitis and its differentiation from other diseases. A pivotal factor in the diagnosis of Acute Pancreatitis is identifying an increase in pancreatic enzymes in the blood. Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected Acute Pancreatitis. Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraperitoneal complications. Computed tomography (CT) is also one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of Acute Pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the Pancreatitis is unknown. When Acute Pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by Acute Pancreatitis are present. Because the etiology of Acute Pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced Acute Pancreatitis, which requires treatment of the biliary system, and alcohol-induced Acute Pancreatitis, which requires a different form of treatment.

Masahiro Yoshida – One of the best experts on this subject based on the ideXlab platform.

  • New diagnostic criteria of Acute Pancreatitis
    Journal of Hepato-Biliary-Pancreatic Sciences, 2010
    Co-Authors: Seiki Kiriyama, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Toshifumi Gabata, Masumi Kadoya, Eigoro Yamanouchi, Takayuki Hattori
    Abstract:

    Practical guidelines for the diagnosis of Acute Pancreatitis are presented so that a rapid and adequate diagnosis can be made. When Acute Pancreatitis is suspected in patients with Acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of Acute Pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other Acute abdominal diseases are ruled out if local findings associated with Pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having Acute Pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting Acute Pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of Acute Pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than Pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of Acute Pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of Acute Pancreatitis. Elucidation of the etiology of Acute Pancreatitis should be continued after a diagnosis of Acute Pancreatitis. In the process of the etiologic elucidation of Acute Pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced Acute Pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US.

  • Gallstone-induced Acute Pancreatitis.
    Journal of hepato-biliary-pancreatic sciences, 2009
    Co-Authors: Yasutoshi Kimura, Kazunori Takeda, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Shinju Arata, Toshifumi Gabata, Hodaka Amano
    Abstract:

    In the care of Acute Pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced Acute Pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced Acute Pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced Acute Pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced Pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced Acute Pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

  • JPN Guidelines for the management of Acute Pancreatitis: diagnostic criteria for Acute Pancreatitis
    Journal of hepato-biliary-pancreatic surgery, 2006
    Co-Authors: Masaru Koizumi, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Miho Sekimoto, Masahiko Hirota, Yasutoshi Kimura, Kazunori Takeda
    Abstract:

    The currently used diagnostic criteria for Acute Pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) Acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with Acute Pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and Acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of Acute Pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations: Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of Acute Pancreatitis and its differentiation from other diseases. A pivotal factor in the diagnosis of Acute Pancreatitis is identifying an increase in pancreatic enzymes in the blood. Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected Acute Pancreatitis. Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraperitoneal complications. Computed tomography (CT) is also one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of Acute Pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the Pancreatitis is unknown. When Acute Pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by Acute Pancreatitis are present. Because the etiology of Acute Pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced Acute Pancreatitis, which requires treatment of the biliary system, and alcohol-induced Acute Pancreatitis, which requires a different form of treatment.

Toshihiko Mayumi – One of the best experts on this subject based on the ideXlab platform.

  • New diagnostic criteria of Acute Pancreatitis
    Journal of Hepato-Biliary-Pancreatic Sciences, 2010
    Co-Authors: Seiki Kiriyama, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Toshifumi Gabata, Masumi Kadoya, Eigoro Yamanouchi, Takayuki Hattori
    Abstract:

    Practical guidelines for the diagnosis of Acute Pancreatitis are presented so that a rapid and adequate diagnosis can be made. When Acute Pancreatitis is suspected in patients with Acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of Acute Pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other Acute abdominal diseases are ruled out if local findings associated with Pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having Acute Pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting Acute Pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of Acute Pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than Pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of Acute Pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of Acute Pancreatitis. Elucidation of the etiology of Acute Pancreatitis should be continued after a diagnosis of Acute Pancreatitis. In the process of the etiologic elucidation of Acute Pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced Acute Pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US.

  • Gallstone-induced Acute Pancreatitis.
    Journal of hepato-biliary-pancreatic sciences, 2009
    Co-Authors: Yasutoshi Kimura, Kazunori Takeda, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Shinju Arata, Toshifumi Gabata, Hodaka Amano
    Abstract:

    In the care of Acute Pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced Acute Pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced Acute Pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced Acute Pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced Pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced Acute Pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

  • JPN Guidelines for the management of Acute Pancreatitis: diagnostic criteria for Acute Pancreatitis
    Journal of hepato-biliary-pancreatic surgery, 2006
    Co-Authors: Masaru Koizumi, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Miho Sekimoto, Masahiko Hirota, Yasutoshi Kimura, Kazunori Takeda
    Abstract:

    The currently used diagnostic criteria for Acute Pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) Acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with Acute Pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and Acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of Acute Pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations: Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of Acute Pancreatitis and its differentiation from other diseases. A pivotal factor in the diagnosis of Acute Pancreatitis is identifying an increase in pancreatic enzymes in the blood. Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected Acute Pancreatitis. Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraperitoneal complications. Computed tomography (CT) is also one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of Acute Pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the Pancreatitis is unknown. When Acute Pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by Acute Pancreatitis are present. Because the etiology of Acute Pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced Acute Pancreatitis, which requires treatment of the biliary system, and alcohol-induced Acute Pancreatitis, which requires a different form of treatment.

Koichi Hirata – One of the best experts on this subject based on the ideXlab platform.

  • New diagnostic criteria of Acute Pancreatitis
    Journal of Hepato-Biliary-Pancreatic Sciences, 2010
    Co-Authors: Seiki Kiriyama, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Toshifumi Gabata, Masumi Kadoya, Eigoro Yamanouchi, Takayuki Hattori
    Abstract:

    Practical guidelines for the diagnosis of Acute Pancreatitis are presented so that a rapid and adequate diagnosis can be made. When Acute Pancreatitis is suspected in patients with Acute onset of abdominal pain and tenderness mainly in the upper abdomen, the diagnosis of Acute Pancreatitis is made on the basis of elevated levels of pancreatic enzymes in the blood and/or urine. Furthermore, other Acute abdominal diseases are ruled out if local findings associated with Pancreatitis are confirmed by diagnostic imaging. According to the diagnostic criteria established in Japan, patients who present with two of the following three manifestations are diagnosed as having Acute Pancreatitis: characteristic upper abdominal pain, elevated levels of pancreatic enzymes, and findings of ultrasonography (US), CT or MRI suggesting Acute Pancreatitis. Detection of elevated levels of blood pancreatic enzymes is crucial in the diagnosis of Acute Pancreatitis. Measurement of blood lipase is recommended, because it is reported to be superior to all other pancreatic enzymes in terms of sensitivity and specificity. For measurements of the blood amylase level widely used in Japan, it should be cautioned that, because of its low specificity, abnormal high values are also often obtained in diseases other than Pancreatitis. The cut-off level of blood pancreatic enzymes for the diagnosis of Acute Pancreatitis is not able to be set because of lack of sufficient evidence and consensus to date. CT study is the most appropriate procedure to confirm image findings of Acute Pancreatitis. Elucidation of the etiology of Acute Pancreatitis should be continued after a diagnosis of Acute Pancreatitis. In the process of the etiologic elucidation of Acute Pancreatitis, judgment whether it is gallstone-induced or not is most urgent and crucial for deciding treatment policy including the assessment of whether endoscopic papillary treatment should be conducted or not. The diagnosis of gallstone-induced Acute Pancreatitis can be made by combining detection of elevated levels of bilirubin, transamylase (ALT, AST) and ALP detected by hematological examination and the visualization of gallstones by US.

  • Gallstone-induced Acute Pancreatitis.
    Journal of hepato-biliary-pancreatic sciences, 2009
    Co-Authors: Yasutoshi Kimura, Kazunori Takeda, Tadahiro Takada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Masahiko Hirota, Shinju Arata, Toshifumi Gabata, Hodaka Amano
    Abstract:

    In the care of Acute Pancreatitis, a prompt search for the etiologic condition of the disease should be conducted. A differentiation of gallstone-induced Acute Pancreatitis should be given top priority in its etiologic diagnosis because it is related to the decision of treatment policy. Examinations necessary for diagnosing gallstone-induced Acute Pancreatitis include blood tests and ultrasonography. Early ERCP/ES should be performed in patients with gallstone-induced Acute Pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. The treatment for bile duct stones with the use of ERCP/ES alone is not recommended in cases of gallstone-induced Pancreatitis with gallbladder stones. Cholecystectomy for gallstone-induced Acute Pancreatitis should be performed using a laparoscopic procedure as the first option as soon as the disease has subsided.

  • JPN Guidelines for the management of Acute Pancreatitis: diagnostic criteria for Acute Pancreatitis
    Journal of hepato-biliary-pancreatic surgery, 2006
    Co-Authors: Masaru Koizumi, Tadahiro Takada, Yoshifumi Kawarada, Koichi Hirata, Toshihiko Mayumi, Masahiro Yoshida, Miho Sekimoto, Masahiko Hirota, Yasutoshi Kimura, Kazunori Takeda
    Abstract:

    The currently used diagnostic criteria for Acute Pancreatitis in Japan are presentation with at least two of the following three manifestations: (1) Acute abdominal pain and tenderness in the upper abdomen; (2) elevated levels of pancreatic enzyme in the blood, urine, or ascitic fluid; and (3) abnormal imaging findings in the pancreas associated with Acute Pancreatitis. When a diagnosis is made on this basis, other pancreatic diseases and Acute abdomen can be ruled out. The purpose of this article is to review the conventional criteria and, in particular, the various methods of diagnosis based on pancreatic enzyme values, with the aim of improving the quality of diagnosis of Acute Pancreatitis and formulating common internationally agreed criteria. The review considers the following recommendations: Better even than the total blood amylase level, the blood lipase level is the best pancreatic enzyme for the diagnosis of Acute Pancreatitis and its differentiation from other diseases. A pivotal factor in the diagnosis of Acute Pancreatitis is identifying an increase in pancreatic enzymes in the blood. Ultrasonography (US) is also one of the procedures that should be performed in all patients with suspected Acute Pancreatitis. Magnetic resonance imaging (MRI) is one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraperitoneal complications. Computed tomography (CT) is also one of the most important imaging procedures for diagnosing Acute Pancreatitis and its intraabdominal complications. CT should be performed when a diagnosis of Acute Pancreatitis cannot be established on the basis of the clinical findings, results of blood and urine tests, or US, or when the etiology of the Pancreatitis is unknown. When Acute Pancreatitis is suspected, chest and abdominal X-ray examinations should be performed to determine whether any abnormal findings caused by Acute Pancreatitis are present. Because the etiology of Acute Pancreatitis can have a crucial influence on both the treatment policy and severity assessment, it should be evaluated promptly and accurately. It is particularly important to differentiate between gallstone-induced Acute Pancreatitis, which requires treatment of the biliary system, and alcohol-induced Acute Pancreatitis, which requires a different form of treatment.