Critical Care Obstetrics part 39 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Acute Pancreatitis Figure Computed tomography scan demonstrating necrosis in the head of the pancreas curved arrow and free fluid in the anterior pararenal space straight arrow . Courtesy of Dr Paula Woodward. Figure Computed tomography scan demonstrating pseudocyst in the tail of the pancreas arrow . Courtesy of Dr Paula Woodward. Table Differential diagnosis of acute pancreatitis. rated these findings noting no difference in amylase activity related to pregnancy. Lipase levels were also studied and no significant difference was found between the second and third trimesters or compared with non-pregnant controls although one study noted a lower lipase level in the first trimester 34 . Mean values of lipase in 175 women were approximately 12 IU L with none exceeding 30 IU L. As a screening tool for acute pancreatitis urinary trypsinogen-2 has also been evaluated in the general population. Using a dipstick test for urinary trypsinogen-2 Kemppainen et al. 35 evaluated 500 consecutive patients presenting to the emergency room with abdominal pain. The authors found 94 sensitivity and 95 specificity in detecting acute pancreatitis. While requiring further study the 99 negative predictive value achieved with this urinary dipstick test may prove a useful adjunctive test to standard serum evaluation of amylase and lipase. Leukocytosis hyperglycemia hyperbilirubinemia abnormal coagulation tests and elevated liver enzymes may also be present. Although other diseases can result in abnormal values amylase and lipase remain the cornerstone of diagnosis. These values are typically elevated more than threefold over normal. Radiologic evaluation While the diagnosis of acute pancreatitis is based on clinical suspicion physical examination and elevated amylase and lipase radiologic tests aid in the confirmation of acute pancreatitis and can be used to monitor the development and progression of complications. A plain film of the abdomen may show dilation of an isolated
