CLINICAL QUESTION

Which patients with acute abdominal pain and elevated lipase levels have acute pancreatitis?

EVIDENCE SUMMARY

Typical symptoms of acute pancreatitis include upper abdominal pain that radiates to the back and nausea and vomiting. Signs may include abdominal tenderness to palpation, guarding, and distension with hypoactive bowel sounds¹; however, individual signs and symptoms have not been well studied for their accuracy.

The diagnostic accuracy of individual laboratory tests for the diagnosis of acute pancreatitis is well studied.² A Cochrane review of 10 studies with 5,096 participants evaluated the accuracy of serum amylase, serum lipase, and urinary trypsinogen.³ Table 1 summarizes these results.³ All tests had similar accuracy; however, other studies have found that approximately one-half of patients with a serum lipase level above three times the upper limit of normal (ULN) do not have acute pancreatitis.^4,5 Other conditions, such as small bowel obstruction, gastroenteritis, biliary tract disease, hepatitis, kidney failure, and alcohol intoxication, can also cause significant elevation in serum lipase levels.⁴