I'm back with Adam Thomas on the Internet Book of Critical Care podcast here to explore

pancreatitis, a topic which is a bit of a pet peeve of mine in various ways.

It's hard to get Josh really fired up.

So I'm excited about this one.

It's a great white whale.

And pancreatitis is one of those beasts that we

were just talking about. A lot of people get fired up about it and intimidated. So it's important

for you guys to have a really solid approach to this. So today we're going to cover diagnosis,

tests to do after you've diagnosed pancreatitis. Risk stratification and disposition. And that is

important before we cover treatment of severe acute

pancreatitis. And then we'll end off with the fantastic checklist and some pitfalls. So let's start

off at the basics here, Josh. How do I actually know my patient in front of me has pancreatitis?

What's that clinical and investigation approach? So the diagnostic criteria for pancreatitis requires at least two of the following three

criteria. Number one, a lipase three times the upper limit of normal. So if the lipase is a little

elevated, I don't care. It needs to be three times the upper limit normal. Number two, clinical

history suggestive of pancreatitis, pain, nausea, vomiting, that sort of stuff. And number three,

imaging, typically a CAT scan showing evidence of pancreatitis. In each one of these criteria by

themselves is insufficient to make the diagnosis. So if a patient just says one of these criteria,

they don't have pancreatitis and you don't need to go crazy about it. So elevation of lipase more

than three times, clinical history and imaging. Got it. Two out of

three, that's what you need. So what am I going to do for labs if I'm worried about this? I'm going to fire off an amylase?

Fire off a lipase? What am I going to do? Basically, lipase has replaced amylase. I personally don't

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