There are no pathognomonic symptoms in acute pancreatitis. In reaching a diagnosis the patient’s history, physical findings, and serum amylase or lipase concentrations have to be considered. Serum amylase is one of the oldest clinically useful laboratory tests, having been around for almost 70 years.1 However, too great a reliance on amylase or lipase will lead to underdiagnosis owing to the lack of sensitivity and specificity.2

Up to 20% of patients with acute pancreatitis run a severe clinical course and these patients must be identified as quickly as possible. The “gold standard” for staging patients with acute pancreatitis is dynamic contrast enhanced computed tomography.3 Disease severity, however, may only become apparent at laparotomy (or necropsy). Operative intervention is not needed in uncomplicated cases and should be avoided if at all posssible in severe acute pancreatitis. Researchers have also attempted to differentiate between mild and severe forms of acute pancreatitis using so-called indicators of necrosis in blood or urine. Examples of these parameters are C-reactive protein (CRP), PMN elastase, phospholipase A₂, antiproteases, and cytokines.4-8 …