A 40year old male was bought to the hospital with acute pain in the upper abdomen. Patient was in shock with feeble pulse and tachycardia. There was tenderness present in the epigastrium. There is no blood in the gastric aspirate and the patieny felt better after aspiration. XRay abdomen showed ni free gas under the diaphragm. Investigation revealed TLC 13500 serum bilirubin 2.0 mg and serum amylase 800IU.The most likely diagnosis is

Clinical features of acute pancreatitis Cardinal symptoms : Epigastric and /or peri umbilical pain that radiates to the back, relieved by sitting & leaning forward Upto 90% of patients have nausea and/or vomiting that typically does not releive on pain Nature of the pain is constant Dehydration, poor skin turgor, tachycardia, hypotension & dry mucous membranes are commonly seen in patients with AP Mild-pancreatitis: Abdomen may be normal of reveal only mild epigastric tenderness Severe pancreatitis : Significant abdominal distension, associated with generalised rebound tenderness and abdominal rigidity Flank (Grey Turner), peri umbilical (cullen's sign) & inguinal ecchymosis (Fox sign) are indicative of retro peritoneal bleeding associated with severe pancreatitis Dullness to percussion and decreased breathing sounds in left or less commonly, in the right hemithorax suggest pleural effusion Diagnosis Corner Stone of the diagnosis of AP: Clinical findings +elevation of pancreatic enzyme level in the plasma Pancreatic enzymes A threefold or higher elevation of amylase & lipase levels confirms the diagnosis Amylase's serum half - life is shoer as compared with lipase Lipase is also a more specific marker of AP because serum amylase levels can be elevated in a number of conditions, such as peptic ulcer disease, mesentric ischaemia, salpingitis and microamylasemia Patients with AP are typically hyperglycemic; they can also have leukocytosis and abnormal elevation of liver enzyme levels Elevation of ALT levels in the serum in the context of AP has a positive predictive value of 95% in the diagnosis of acute biliary pancreatitis X-Ray abdomen Localized ileus of duodenum and proximal jejunum (sentinel loop) or that of transverse colon up to its mid point (colon cut off sign) IOC for acute pancreatitis : CECT Ref: Sabiston 20th edition Pgno :1524-1528