[Diagnosis of acute pancreatitis]

The diagnosis of acute pancreatitis is based on clinical examination as described by Fitz in 1889 and on laboratory tests. Amylase and lipase levels in the blood are the most useful of the latter. The severity of acute pancreatitis is classically graded by the Ranson and Imrie scores: both systems are specific for acute pancreatitis but request 48 hours for a prognosis to be defined. Non specific prognostic scores such as APACHE II and SAPS avoid such a delay. Recent studies suggest that single biologic markers such as C-reactive protein and trypsinogen activation peptides may soon allow a simple and early assessment of the prognosis. In the meantime, CT is the reference diagnostic method whenever pathologic proof of the disease is lacking; such imaging strengthens the prognostic value of the bioclinical scores.