Role of Biochemical Investigation in Prediction of Biliary Etiology in Acute Pancreatitis

  • Tanka Prasad Bohara Kathmandu Medical College Teaching Hospital
  • Anuj Parajuli Kathmandu Medical College Teaching Hospital
  • Mukund Raj Joshi Kathmandu Medical College Teaching Hospital

Abstract

Introduction: Acute pancreatitis is common clinical resentation. Gall stone disease and alcohol consumption are most common etiologies. Detection of biliary etiology is important in order to provide definite management in form of cholecystectomy to prevent further attacks. Sensitivity 
for abdominal ultrasound to detect cholelithiasis is decreased to 67–87% in presence of acute pancreatitis. Difference in biochemical investigations of acute biliary and non-biliary pancreatitis has been proposed to increase the suspicion of biliary etiology.

Methods: Sixty patients admitted with diagnosis of acute pancreatitis from March 2012 to December 2012 were included in the study. The relation between etiology with age, sex, admission serum amylase and liver function test were evaluated.

Results: Out of 60 patients 38 (63.33%) and 22 (36.66%) had biliary and non-biliary etiology respectively. Biliary pancreatitis was more common in females (25 vs. 3). Distribution of severity was comparable between both groups. Biliary pancreatitis group had significantly higher amylase level (3466.42 vs. 1987.5, p 0.003) whereas values of liver function test were higher in biliary pancreatitis 
though not statistically significant.

Conclusions: A simple, rapid and accurate prediction of biliary etiology of acute pancreatitis can be provided by changes in biochemical parameters.

Keywords: Acute Pancreatitis; Biliary Pancreatitis; Serum Amylase.  

Author Biographies

Tanka Prasad Bohara, Kathmandu Medical College Teaching Hospital
Lecturer
Anuj Parajuli, Kathmandu Medical College Teaching Hospital
Resident
Mukund Raj Joshi, Kathmandu Medical College Teaching Hospital
Associate Professor

References

1. Trikudanathan G, Navneethan U, Vege SS. Current controversies in fluid resuscitation in acute pancreatitis: a systematic review. Pancreas. 2012 Aug;41(6):827-34.

2. Banks PA. Epidemiology, natural history, and predictors of disease outcome in acute and chronic pancreatitis. Gastrointest Endosc. 2002 Dec;56(6 Suppl):S226–30.

3. Hessler PC, Hill DS, Deforie FM, Rocc FM. High accuracy
sonographic recognition of gallstones. AJR Am J Roentgenol. 1981 Mar;136(3):517–20.

4. Alexakis N, Lombard M, Raraty M, Ghaneh P, Smart HL, Gilmore I, et al. When is pancreatitis considered to be of biliary origin and what are the implications for management? Pancreatology. 2007;7(2-3):131-41.

5. Liu CL, Lo CM, Chan JK, Poon RT, Fan ST. EUS for detection of occult cholelithiasis in patients with idiopathic pancreatitis. Gastrointest Endosc. 2000 Jan;51(1):28-32.

6. Frossard JL, Sosa-Valencia L, Amouyal G, Marty O, Hadengue A, Amouyal P. Usefulness of endoscopic ultrasonography in patients with “idiopathic” acute pancreatitis. Am J Med. 2000 Aug 15;109(3):196-200.

7. Norton SA, Alderson D. Endoscopic ultrasonography in the evaluation of idiopathic acute pancreatitis. Br J Surg. 2000 Dec;87(12):1650-5.

8. Ammori BJ, Boreham B, Lewis P, Roberts SA. The biochemical detection of biliary etiology of acute pancreatitis on admission: a revisit in the modern era of biliary imaging. Pancreas. 2003 Mar;26(2):e32-5.

9. Tenner S, Dubner H, Steinberg W. Predicting gallstone pancreatitis with laboratory parameters: a meta-analysis. Am J Gastroenterol. 1994 Oct;89(10):1863-6.

10. Davidson BR, Neoptolemos JP, Leese T, Carr-Locke DL. Biochemical prediction of gallstones in acute pancreatitis: a prospective study of three systems. Br J Surg. 1988 Mar;75(3):213-5.

11. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013 Jan;62(1):102-11.

12. McMahon MJ, Pickford IR. Biochemical prediction of gallstones early in an attack of acute pancreatitis. Lancet. 1979 Sep 15;2(8142):541-3.

13. Anderson K, Brown LA, Daniel P, Connor SJ. Alanine transaminase rather than abdominal ultrasound alone is an important investigation to justify cholecystectomy in patients presenting with acute pancreatitis. HPB. 2010 Jun;12(5):342-7.

14. Güngör B, Cağlayan K, Polat C, Seren D, Erzurumlu K, Malazgirt Z. The predictivity of serum biochemical markers in acute biliary pancreatitis. ISRN Gastroenterol. 2011;2011:279607.
Published
2013-03-31
How to Cite
Bohara, T., Parajuli, A., & Joshi, M. (2013). Role of Biochemical Investigation in Prediction of Biliary Etiology in Acute Pancreatitis. Journal of Nepal Medical Association, 52(189), 229-232. https://doi.org/10.31729/jnma.264
Section
Original Article

Most read articles by the same author(s)