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
Investigations to consider
- serum triglycerides
- abdominal CT scan (CECT)
- endoscopic ultrasound (EUS)
- magnetic resonance cholangiopancreatography (MRCP)
- arterial blood gas
Treatment algorithm
Contributors
Expert advisers
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 reviewers
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
Editors
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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