| Abstrakt: |
Acute Pancreatitis (AP) is a common condition with an overall mortality rate of 6-15%. Internationally, gall stones and alcohol are the most common causes of pancreatitis. Amylase estimation is technically simple, inexpensive, and sensitive but it has low specificity. Lipase has a greater sensitivity in acute alcoholic pancreatitis and in patients who present late to the emergency room and remains elevated longer than amylase. The presence of elevated liver enzymes usually indicates liver damage. Alanine Transaminase (ALT) is more specific to the liver than Aspartate Transaminase (AST). The present study was conducted to see whether changes in specific biochemical markers are significant enough to act as a diagnostic tool to differentiate between alcoholic pancreatitis and gallstone pancreatitis. Thorough history (especially of alcohol abuse, >4-5 drinks/day) and clinical examination were recorded. Severity grading of all patients was done based on BISAP scoring. Abdominal ultrasound was used for screening for gall stones, common bile duct stones and pancreatitis. Patients diagnosed with gall stone on abdominal ultrasound were tested for liver and pancreatic enzyme levels. A total of 140 cases (70 of each group) was analyzed in this study. There was no statistically significant co-relation of serum amylase, lipase, AST, ALT, ALKP with the severity of pancreatitis. However, a direct co-relation was seen between raised TLC, BUN and severity of pancreatitis. The average serum amylase level was significantly higher for gallstone pancreatitis as compared to alcoholic pancreatitis at presentation. The serum AST, serum ALT, serum bilirubin and serum ALKP levels in gallstone pancreatitis were higher as compared to alcoholic pancreatitis. However, a direct co-relation was seen between raised TLC, BUN, and severity of pancreatitis. Raised biochemical markers like AST, ALT, amylase, lipase, ALP and serum bilirubin can be used as good markers for diagnosis of gallstone pancreatitis. However, a normal or low serum level of these markers does not rule out possibility of gallstones in the aetiology of pancreatitis and may require further evaluation. [ABSTRACT FROM AUTHOR] |
