Acute pancreatitis

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Last reviewed: 18 Aug 2025
Last updated: 24 Oct 2024

Summary

定义

病史和体格检查

关键诊断因素

  • abdominal pain
  • nausea and vomiting
  • anorexia
  • signs of hypovolemia
完整详情

其他诊断因素

  • signs of organ dysfunction
  • Grey-Turner sign
  • Cullen sign
  • Fox sign
  • abdominal distention
完整详情

危险因素

  • middle-aged women
  • young- to middle-aged men
  • gallstones
  • alcohol
  • hypertriglyceridemia
  • hypercalcemia
  • use of causative drugs
  • mumps
  • coxsackievirus
  • Mycoplasma pneumoniae
  • endoscopic retrograde cholangiopancreatography (ERCP)
  • trauma
  • pancreas divisum
  • pancreatic cancer
  • sphincter of Oddi dysfunction
  • family history of pancreatitis
完整详情

诊断性检查

首要检查

  • serum lipase (or amylase if lipase is unavailable)
  • liver function tests
  • CBC and differential
  • hematocrit
  • BUN and serum electrolytes
  • arterial blood gas
  • CRP
  • transabdominal ultrasound
  • chest x-ray
  • ratio of serum lipase:amylase
  • serum triglycerides
完整详情

需考虑的检查

  • abdominal CT scan
  • magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP)
  • endoscopic ultrasound (EUS)
完整详情

新兴检查

  • procalcitonin
完整详情

治疗流程

急症处理

all patients

持续性治疗

deteriorating or failing to improve

撰稿人

专家顾问

Scott Tenner, MD, MPH, JD, FACG

Clinical Professor of Medicine

Director, The Greater New York Endoscopy Surgical Center

Director, Brooklyn Gastroenterology and Endoscopy

State University of New York

NY

利益声明

ST is an author of references cited in this topic. He declares that he has no other competing interests.

Craig T. Tenner, MD, FACP

Associate Professor

Medicine

New York University School of Medicine

NY

利益声明

CTT declares that he has no competing interests.

鸣谢

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

利益声明

NJZ is an author of a reference cited in this topic. BD, CLM, FA, and CB declare that they have no competing interests.

同行评议者

Tamas A. Gonda, MD

Assistant Professor of Medicine

Attending Physician and Director of Research

Columbia University Medical Center

New York

NY

利益声明

TAG declares that he has no competing interests.

Alan Moss, MD

Harvard Medical Faculty Physician

Division of Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

利益声明

AM declares that he has no competing interests.

Derek O'Reilly, MD

Consultant Hepatobiliary & Pancreatic Surgeon

Department of Surgery

North Manchester General Hospital

Manchester

UK

利益声明

DOR is an author of a reference cited in this topic. He declares that he has no other competing interests.

Eric Frykberg, MD

Professor

Department of Surgery

Division General Surgery

Shands Jacksonville Medical Center

FL

利益声明

At the time of the peer review, Dr E. Frykberg declared no competing interests. We were made aware that Dr Frykberg is now deceased.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Tenner S, Vege S, Sheth S, et al. American College of Gastroenterology guidelines: management of acute pancreatitis. Am J Gastroenterol. 2024 Mar 119(3):419-37.全文  摘要

Leppäniemi A, Tolonen M, Tarasconi A, et al. 2019 WSES guidelines for the management of severe acute pancreatitis. World J Emerg Surg. 2019 Jun 13;14:27.全文  摘要

Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013 Jul-Aug;13(4 Suppl 2):e1-15.全文  摘要

American College of Radiology. ACR appropriateness criteria: acute pancreatitis. 2019 [internet publication].全文

Crockett SD, Wani S, Gardner TB, et al. American Gastroenterological Association Institute guideline on initial management of acute pancreatitis. Gastroenterology. 2018 Mar;154(4):1096-101.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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