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Korean J Pancreas Biliary Tract > Volume 18(2):2013 > Article
The Korean Journal of Pancreas and Biliary Tract 2013;18(2):4-13.
급성 췌장염 진료 권고안: 급성 췌장염의 진단
고동희, 김종혁, 이진, 최호순1
한림대학교 의과대학 내과학 교실, 1한양대학교 의과대학 내과학 교실"
Clinical Practice Guidelines for Acute Pancreatitis: The Diagnosis of Acute Pancreatitis
Dong Hee Koh, Jong Hyeok Kim, Jin Lee, Ho Soon Choi
Department of Internal Medicine, Hallym University College of Medicine, Hwaseong, Korea
ABSTRACT
There is general acceptance that a diagnosis of acute pancreatitis requires two of the following three features: 1) abdominal pain characteristic of acute pancreatitis, 2) serum amylase and/or lipase ≥3 times the upper limit of normal, and 3) characteristic findings of acute pancreatitis on ultrasonography, CT or MRI. Other pancreatic diseases and acute abdomen have been ruled out are diagnosed. In pancreatic enzymes, serum lipase may be preferable because it is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis. Contrast-enhanced CT scan is the best imaging technique to exclude conditions that masquerade as acute pancreatitis, to diagnose the severity of acute pancreatitis, and to identify complications of pancreatitis. After the diagnosis of acute pancreatitis has been made, its etiology should be made clear to decide treatment policy of acute pancreatitis or to prevent the recurrence of pancreatitis. The etiology of acute pancreatitis in an emergency situation should be assessed by clinical history, laboratory tests such as serum liver function tests, measurement of serum calcium and serum triglycerides and ultrasonography. 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. Early ERCP should be performed in patients with gallstone pancreatitis if a complication of cholangitis and a prolonged passage disorder of the biliary tract are suspected. Cholecystectomy should be considered after recovery from an attack of gallstone pancreatitis during the same hospital stay. In severe gallstone-induced acute pancreatitis, cholecystectomy should be delayed until there is sufficient resolution of the inflammatory response and clinical recovery.
Keywords: acute pancreatitis, guidelines, diagnostic criteria, gallstone pancreatitis
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