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White blood cell count
29%
2/7
Alkaline phosphatase
0%
0/7
Total bilirubin
Amylase
Lipase
71%
5/7
Select Answer to see Preferred Response
This clinical vignette is consistent with acute gallstone pancreatitis. According to Ranson's criteria, an initial white blood cell count greater than 18,000/uL is associated with increased mortality. The most common causes of acute pancreatitis in adults are gallstones and alcohol. Patients may present with nausea, anorexia, and abdominal pain, characteristically in the epigastric region and radiating to the chest and/or back. Elevated lipase is more specific for pancreatitis than elevated amylase since lipase is produced primarily in the pancreas and may remain elevated for several days longer than amylase. As reviewed by Quinlan, acute pancreatitis may be diagnosed based on presence of at least two of the following three criteria: characteristic abdominal pain, amylase and/or lipase at least three times greater than normal levels, and characteristic imaging findings, usually with contrast enhanced CT that may show pancreatic necrosis and inflammation with or without extrapancreatic involvement. Treatment involves bowel rest, aggressive fluid hydration, and pain control. Potential complications from acute pancreatitis include pseudocyst formation, hemorrhage, infection, and multi-organ failure. Given the high morbidity and mortality associated with acute pancreatitis, multiple predictive scoring systems have been reported. A retrospective study by Papachristou et al. demonstrated similar prognostic accuracy among various scoring systems including Ranson's, APACHE-II, CTSI, and BISAP. Ranson's criteria is one of the earliest scoring systems created, based on two assessments made on presentation and 48 hours later. Estimates are based on age, WBC count, glucose, LDH, AST, hematocrit, BUN, calcium, arterial pO2, base deficit, and fluid needs. Incorrect Answers: Answer 2-5: None of these are included in Ranson's criteria or any other predictive scoring systems for estimating mortality from acute pancreatitis. Of note, amylase and lipase are useful for diagnosis, but are not predictive for prognosis.
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