Clinical and laboratory diagnosis of acute pancreatitis.

Determination of serum pancreatic enzymes remains the gold standard for the diagnosis of acute pancreatitis. Clinical symptoms and signs are of major importance in suspecting the disease, but they are not accurate enough to confirm the diagnosis. Among pancreatic enzymes, total amylase, pancreatic isoamylase and lipase are preferred, since simple, rapid and unexpensive enzymatic methods are commercially available. More expensive and cumbersome methods (e. g. ELISA for pancreatic elastase) are required if a significant delay to hospital admission occurs. In that case, other serum enzymes are usually normal or only lightly increased. To early define the etiology of acute pancreatic serum pancreatic enzymes lack of value. With this purpose, determination of AST, bilirubin and alkaline phosphatase may allow to distinguish between biliary and non-biliary origin of the disease.