A 45 year old male is brought to casualty after a night party with complaints of epigastric pain, penetrating towards back. Which is the best for diagnosis?

Ans. (a) Serum LipaseRef: Harrison 19th ed. / 2100* The cardinal symptom of acute pancreatitis is abdominal pain, which is characteristically dull, boring, and steady.* Usually, the pain is sudden in onset and gradually intensifies in severity until reaching a constant ache.* The pain radiates directly through the abdomen to the back in approximately one half of cases.* Fever (76%) and tachycardia (65%) are common abnormal vital signs; hypotension may be noted* Abdominal tenderness, muscular guarding (68%), and distention (65%) are observed in most patients; bowel sounds are often diminished or absent because of gastric and transverse colonic ileus; guarding tends to be more pronounced in the upper abdomen* Lipase has a slightly longer half-life and its abnormalities may support the diagnosis if a delay occurs between the pain episode and the time the patient seeks medical attention.* Elevated lipase levels are more specific to the pancreas than elevated amylase levels. Lipase levels remain high for 12 days. In patients with chronic pancreatitis (usually caused by alcohol abuse and question mentions that the patient is back from a party), lipase levels may be elevated in the presence of a normal serum amylase level