Viêm tụy là chẩn đoán trên cơ sở của một sự kết hợp các tính năng lâm sàng thích hợp và hoạt động amylase huyết thanh hơn ba lần so với bình thường (330 U / l). Hoạt động thấp hơn không loại trừ các chẩn đoán như amylase huyết thanh hoạt động | ABC of Liver Pancreas and Gall Bladder Diagnosis Pancreatitis is diagnosed on the basis of a combination of appropriate clinical features and a serum amylase activity over three times above normal 330 U l. . Lower activities do not rule out the diagnosis as serum amylase activity may reduce or normalise within the first 24-48 hours. Measurement of urinary amylase activity which remains high for longer periods may be helpful in this situation. Although amylase activity may be raised in several other conditions with similar clinical signs notably perforated peptic ulcer and ischaemic bowel the increase is rarely more than three times above normal. Serum lipase measurement has a higher sensitivity and specificity and now that simpler methods of measurement are available it is likely to become the preferred diagnostic test. Clinical course Whatever the underlying cause of pancreatitis the clinical course is usually similar. The disease process is self limiting in 80 of cases but in severe cases there are usually three phases local inflammation and necrosis a systemic inflammatory response leading to multiple organ dysfunction syndrome during the first two weeks and finally local complications such as the development of a pseudocyst or infection in the pancreatic and peripancreatic necrotic tissue. Assessment of severity Early identification of patients with a severe attack is important as they require urgent admission to a high dependency or intensive care unit. Initial predictors of a severe attack include first attack of alcohol induced pancreatitis obesity haemodynamic instability and severe abdominal signs severe tenderness and haemorrhage of the abdominal wall . Several scoring systems have been developed to predict patients with mild or severe pancreatitis. The most widely used in the United Kingdom is the modified Glasgow system Imrie which has a sensitivity of 68 and a specificity of 84 . Other commonly used systems are Ranson s and the acute physiological and
