Last reviewed: November 2017
Last updated: November  2017

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • nausea
  • vomiting
  • anorexia
  • abdominal pain
  • tachycardia

Other diagnostic factors

  • Grey-Turner's sign
  • Cullen's sign
  • Fox's sign
  • Chvostek's sign
  • hypotension
  • abdominal distension

Risk factors

  • middle-aged women
  • young- to middle-aged men
  • gallstones
  • alcohol
  • hypertriglyceridaemia
  • hypercalcaemia
  • use of causative drugs
  • mumps
  • coxsackievirus
  • Mycoplasma pneumoniae
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • trauma
  • systemic lupus erythematosus
  • Sjogren's syndrome
  • pancreas divisum
  • pancreatic cancer
  • sphincter of Oddi dysfunction
  • FHx of pancreatitis

Diagnostic investigations

1st investigations to order

  • serum lipase
  • serum amylase
  • AST/ALT
  • FBC and differential
  • C-reactive protein (CRP)
  • haematocrit
  • arterial blood gas
  • abdominal plain film
  • CXR
  • transabdominal ultrasound
  • ratio of serum lipase:amylase
Full details

Investigations to consider

  • abdominal CT scan
  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • fine needle aspiration
Full details

Emerging tests

  • urinary trypsinogen-2
  • serum IL-6
  • serum IL-8
Full details

Treatment algorithm

ACUTE

Contributors

Authors VIEW ALL

Associate Professor of Surgery

Department of Surgery

Indiana University

Indianapolis

IN

Disclosures

NJZ is an author of a reference cited in this monograph.

Dr Nicholas J. Zyromski would like to gratefully acknowledge Dr Brian Daley, Dr Catherine Lindsay McKnight, and Dr Fernando Aycinena, previous contributors to this monograph. He would also like to thank Dr Camille Blackledge for her contribution to this monograph. BD, CLM, FA, and CB declare that they have no competing interests.

Peer reviewers VIEW ALL

Assistant Professor of Medicine

Attending Physician and Director of Research

Columbia University Medical Center

New York

NY

Disclosures

TAG declares that he has no competing interests.

Harvard Medical Faculty Physician

Division of Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

AM declares that he has no competing interests.

Consultant Hepatobiliary & Pancreatic Surgeon

Department of Surgery

North Manchester General Hospital

Manchester

UK

Disclosures

DOR is an author of a reference cited in this monograph. He declares that he has no other competing interests.

Professor

Department of Surgery

Division General Surgery

Shands Jacksonville Medical Center

FL

Disclosures

At the time of the peer review, Dr E. Frykberg declared no competing interests. We were made aware that Dr Frykberg is now deceased.

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