Acute pancreatitis

Last reviewed: 1 Jan 2023
Last updated: 24 Jun 2022



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


all patients


deteriorating or failing to improve after 5-7 days


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



AA declares that he has no competing interests.


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



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



Peer reviewers

Sven van Dijk, MD

Department of Surgery

Amsterdam UMC

University of Amsterdam


Department of Surgery

St Antonius Hospital


The Netherlands


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


The Netherlands


None declared


Jo Haynes

Head of Editorial, BMJ Knowledge Centre


JH declares that she has no competing interests.

Tannaz Aliabadi-Oglesby

Lead Section Editor, BMJ Best Practice


TAO declares that she has no competing interests.

Julie Costello

Comorbidities Editor, BMJ Best Practice


JC declares that she has no competing interests.

Adam Mitchell

Drug Editor, BMJ Best Practice


AM declares that he has no competing interests.

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