Acute pancreatitis

Last reviewed: 4 Sep 2022
Last updated: 29 Mar 2022

Summary

Definition

History and exam

Key diagnostic factors

  • abdominal pain
  • nausea and vomiting
  • anorexia
  • signs of hypovolemia
More key diagnostic factors

Other diagnostic factors

  • signs of organ dysfunction
  • Grey-Turner sign
  • Cullen sign
  • Fox sign
  • Chvostek sign
  • abdominal distention
Other diagnostic factors

Risk factors

  • 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
More risk factors

Diagnostic investigations

1st investigations to order

  • serum lipase or amylase
  • 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
More 1st investigations to order

Investigations to consider

  • abdominal CT scan
  • magnetic imaging/magnetic resonance cholangiopancreatography (MRI/MRCP)
  • endoscopic ultrasound (EUS)
More investigations to consider

Emerging tests

  • procalcitonin

Treatment algorithm

ACUTE

all patients

ONGOING

deteriorating or failing to improve

Contributors

Authors

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

Disclosures

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

Disclosures

CTT declares that he has no competing interests.

Acknowledgements

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.

Disclosures

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

Peer reviewers

Tamas A. Gonda, MD

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.

Alan Moss, MD

Harvard Medical Faculty Physician

Division of Gastroenterology

Beth Israel Deaconess Medical Center

Boston

MA

Disclosures

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

Disclosures

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

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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