<prompt> Which of the following is most diagnostic investigation for acute pancreatitis?Serum amylaseSerum lipaseSerum P - isoamylaseSerum LDH  <response>: Ans. b Serum lipase. Ref. Bailey Love, 25th 1123 A serum amylase level three to four times above normal is indicative of acute pancreatitis. A normal serum amylase level does not exclude acute pancreatitis, particularly if the patient has presented a few days later. If the serum lipase levels can be checked, it provides a more sensitive and specific test than amylase. If there is doubt, and other causes of acute abdomen have to be excluded, CECT is the best single imaging investigation. At present, CT severity scoring Balthazar scoring is one of the most vital prognostic factors.SubjectiveAcute onset steady, intense epigastric abdominal pain radiating to the back with nausea and vomiting; may be relieved with leaning forward; medical history: chronic alcoholism, gallstones ObjectiveMild: Restlessness, low-grade fever, tachycardia, mild epigastric tendernessSevere: Same as mild plus marked tenderness with guarding and abdominal distension, absent bowel sounds, systemic signs of hypotension, possible shock, jaundice, and pulmonary findings, e.g,, rales, pulmonary edemaLaboratory results: Elevated serum andor urinary levels of pancreatic enzymes e.g., amylase lipase, C.reactive protein, or trypsinogen activation peptide: consider liver function tests, calcium, triglycerides, albumin, complete blood count, arterial blood gases, glucoseImaging: Ultrasonography: contrast-enhanced CT or MRI with elevated serum creatinine and MRCP or ERCP if high suspicion of common bile duct stones Differential diagnosisAcute or chronic alcohol consumption; gallstone disease; peptic ulcer disease; perforated ulcer; early appendicitis; bowel obstruction; mesenteric Ischemia; medications; hypertriglyceridemia; hypercalcemia; infection; post-traumatic injury; pregnancy; pulmonary renal or cardiovascular disorders AssessmentRansons CrilteriaAPACHE IICT Severity Index Mild pancreatitis 3Severe pancreatitis 38877 PlanManagement of mild pancreatitis- Aggressive rehydration i.e., dextrose in normal saline at 1 L per hour until adequate urine output- Pain relief morphine- Enteral nutritional support once pain improves and laboratory results normalize- Monitor hemodynamic and laboratory serum parameters Management of severe pancreatitis- Consider intensive care unit admission- Eliminate oral intake for first 48 hours- Aggressive volume replacement- Nutritional support enteral preferred- Consider emergency ERCP with suspected gallstones and obstructive jaundice- Pain relief morphine- Identify if pancreatic or peripancreatic necrosis is present- Consider antibiotics if possible infection- Consider consultation with gastroenterology, surgery, andor interventional radiology subspecialists 