Last reviewed: 27 Oct 2020
Last updated: 05 Mar 2020

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

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

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
  • family history of pancreatitis

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

Contributors

Expert advisersVIEW ALL

Emergency Medicine Consultant

Royal London Hospital

Barts Health NHS Trust

London

Honorary Senior Lecturer

Queen Mary University

London

UK

Disclosures

JG declares that he has no competing interests.

BMJ Best Practice would like to gratefully acknowledge the previous expert contributor, 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 

Disclosures

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

Peer reviewersVIEW ALL

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.

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

Head of Editorial, BMJ Knowledge Centre

Disclosures

JH declares that she has no competing interests.

Lead Section Editor, BMJ Best Practice

Disclosures

TAO declares that she has no competing interests.

Comorbidities Editor, BMJ Best Practice

Disclosures

JC declares that she has no competing interests.

Drug Editor, BMJ Best Practice

Disclosures

AM declares that he has no competing interests.

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