Question

A female presenting with abdominal pain, distension, organ failure in last 24 hours. CT scan shows pancreas which is bulky & there is fluid density lesion in the pancreas. Which of the following will be increased.

• A. AST
• B. Lipase
• C. Creatine Kinase
• D. Blood Urea Nitrogen

Hint:

A bulky pancreas with fluid density on CT in an acutely ill patient points to pancreatitis -- think which pancreatic enzyme is most specific.

Answer 1

The Correct Option is B

Step 1: Identify the diagnosis. The CT scan finding of a bulky pancreas with fluid density lesion (peripancreatic fluid collection or pseudocyst precursor) in the context of acute abdominal pain, distension, and organ failure within 24 hours is diagnostic of acute pancreatitis.

Step 2: Identify the elevated enzyme.

• Lipase is the most specific and sensitive marker for acute pancreatitis. It rises within 4-8 hours of onset, peaks at 24 hours, and remains elevated for 8-14 days. It is more specific than amylase because lipase is produced predominantly by the pancreatic acinar cells.
• AST is elevated in liver pathology (hepatitis, cholangitis) -- not specific for pancreatitis.
• Creatine Kinase is elevated in muscle damage, myocardial infarction, or rhabdomyolysis -- not pancreatitis.
• Blood Urea Nitrogen may rise in severe pancreatitis due to prerenal azotaemia but is not the primary marker.

Step 3: Conclusion. In acute pancreatitis, both amylase and lipase are elevated. Lipase is the preferred diagnostic enzyme due to higher specificity and prolonged elevation.