Diagnostic approach to acute pancreatitis: diagnosis, assessment of etiology and prognosis.

The aims of initial diagnostic procedures leading to early treatment in an appropriate setting in acute pancreatitis are: initial diagnosis and differential diagnosis, assessment of etiology and assessment of prognosis. Etiology can be assessed with certainty only by endoscopic retrograde cholangiopancreaticography. This method allows us to differentiate between pancreatic duct abnormalities as seen in so-called alcoholic pancreatitis as an exacerbation of chronic pancreatitis and biliary causes of the disease. Contrast-guided computed tomography is useful for detecting necroses and their infection. As in other inflammatory diseases, the prognosis in acute pancreatitis seems to be determined by mediators leading to "whole body inflammation", confirmed by high concentrations of interleukin-8 as a major attractant of neutrophils, by interleukin-6 preceding high levels of CRP, as well as by leukocyte immigration into the pancreas. Besides these determinants of the course of acute pancreatitis the prognosis can be assessed by simple clinical means. A clinical score based on physical examination seems to be the best standard for assessing prognosis. Measurement of PMN-elastases and CRP may be additionally helpful.