Diagnosis and Severity of Acute Pancreatitis

The most frequent presentation of acute pancreatitis (AP) is acute-onset upper abdominal pain, so intense that most patients seek urgent medical attention early in the course of the disease. Abdominal pain is almost universal, but it may not be apparent due to special circumstances like sedation, dementia, or immunosuppression. An increase in pancreatic enzyme serum activity is very frequent in AP, and a key diagnostic criterion, but it is not a perfect test, since some patients have normal levels (lowering sensitivity) and many diseases can be associated with an elevated serum pancreatic enzyme activity (lowering specificity) [1]. Overall, patients with AP have variable outcomes, with most patients having a mild course of the disease, while others have a fulminant disease or relevant morbidity. Local and systemic complications are present in one-third of patients with more severe disease, increasing morbidity and increasing the risk of death. The prediction of AP severity is important for decisions relating to triage, patient transfer, treatments and allocation in trials. The classification of severity is more important for audit of outcomes and communication between clinicians.