Acute pancreatitis

Last reviewed: 18 Jul 2022
Last updated: 24 Jun 2022

Summary

Definition

History and exam

Key diagnostic factors

  • upper abdominal pain
  • nausea and vomiting
  • signs of hypovolaemia
  • signs of pleural effusion
  • anorexia
  • presence of risk factors
Full details

Other diagnostic factors

  • signs of organ dysfunction
  • dyspnoea
  • jaundice
  • Chvostek’s sign
  • ecchymotic bruising and discolouration (Cullen’s/Grey-Turner’s/Fox’s sign) (rare)
Full details

Risk factors

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

Diagnostic investigations

1st investigations to order

  • serum lipase or amylase
  • FBC and differential
  • C-reactive protein (CRP)
  • urea/creatinine
  • pulse oximetry
  • LFTs
  • CXR
  • transabdominal ultrasound
  • serum calcium
Full details

Investigations to consider

  • serum triglycerides
  • abdominal CT scan (CECT)
  • endoscopic ultrasound (EUS)
  • magnetic resonance cholangiopancreatography (MRCP)
  • arterial blood gas
Full details

Emerging tests

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

Treatment algorithm

ACUTE

all patients

ONGOING

deteriorating or failing to improve after 5-7 days

Contributors

Expert advisers

Alexander Alexiou, MBBS, BSc, DCH, FRCEM, Dip IMC RCSEd

Emergency Medicine Consultant

Barts Health NHS Trust

Physician Response Unit Consultant

London’s Air Ambulance

Royal London Hospital

UK

Disclosures

AA declares that he has no competing interests.

Acknowledgements

BMJ Best Practice would like to gratefully acknowledge the previous expert contributors, whose work has been retained in parts of the content:

Nicholas J. Zyromski, MD

Associate Professor of Surgery

Department of Surgery

Indiana University

Indianapolis

IN

Johann Grundlingh, MBChB, FCEM, FFICM, EDICM, DFMS, DipMedTox, MMedTox, MSB, ERT, MEWI, MBA

Emergency Medicine Consultant

Royal London Hospital

Barts Health NHS Trust

Honorary Senior Lecturer

Queen Mary University

London

UK

Peer reviewers

Sven van Dijk, MD

Department of Surgery

Amsterdam UMC

University of Amsterdam

Amsterdam

Department of Surgery

St Antonius Hospital

Nieuwegein

The Netherlands

Disclosures

SvD declares that he has no competing interests.

Marc G Besselink, MD, PhD, MSc

Hepatopancreatobiliary Surgeon

Department of Surgery

Amsterdam UMC

University of Amsterdam

Principal Investigator

Dutch Pancreatitis Study Group

Academic Medical Center

Amsterdam

The Netherlands

Disclosures

None declared

Editors

Jo Haynes,

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Tannaz Aliabadi-Oglesby,

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Adam Mitchell,

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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