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Harrison's Principles of Internal Medicine, 18e
| Part 14. Disorders of the Gastrointestinal System > Section 3. Disorders of the Pancreas > |
Chapter 312. Approach to the Patient with Pancreatic Disease
Sections: Approach to the Patient with Pancreatic Disease: Introduction.
Topics Discussed: pancreatic diseases; pancreatitis; pancreatitis, acute; pancreatitis, chronic.
Excerpt:"As emphasized in Chap. 313, the etiologies as well as the clinical manifestations of pancreatitis are quite varied. Although it is well-appreciated that pancreatitis is frequently secondary to biliary tract disease and alcohol abuse, it can also be caused by drugs, trauma, and viral infections and is associated with metabolic and connective tissue disorders. In  30% of patients with acute pancreatitis and 25–40% of patients with chronic pancreatitis, the etiology initially can be obscure.The serum amylase and lipase levels are widely used as screening tests for acute pancreatitis in the patient with acute abdominal pain or back pain. Values greater than three times the upper limit of normal virtually clinch the diagnosis if gut perforation or infarction is excluded. In acute pancreatitis, the serum amylase and lipase are usually elevated within 24 hours of onset and remains so for 3–7 days. Levels usually return to normal within 7 days unless there is pancreatic ductal disruption, ductal obstruction, or pseudocyst formation. Approximately 85% of patients with acute pancreatitis have a threefold or greater elevated serum amylase and lipase levels. The values may be normal if (1) there is a delay (of 2–5 days) before..."
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