Last reviewed: May 2019
Last updated: January  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • abdominal pain
  • nausea and vomiting
  • anorexia
  • signs of hypovolaemia

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
  • family history of pancreatitis

Diagnostic investigations

1st investigations to order

  • serum lipase or amylase
  • aspartate aminotransferase/alanine aminotransferase
  • FBC and differential
  • CRP
  • haematocrit
  • arterial blood gas
  • abdominal plain film
  • CXR
  • trans-abdominal ultrasound
  • ratio of serum lipase:amylase
Full details

Investigations to consider

  • abdominal CT scan
  • magnetic resonance cholangiopancreatography (MRCP)
  • endoscopic ultrasound (EUS)
Full details

Emerging tests

  • urinary trypsinogen-2
  • serum interleukin-6
  • serum interleukin-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 topic.

Dr Nicholas J. Zyromski would like to gratefully acknowledge Dr Brian Daley, Dr Catherine Lindsay McKnight, and Dr Fernando Aycinena, previous contributors to this topic. He would also like to thank Dr Camille Blackledge for her contribution to this topic. 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 topic. 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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