Last reviewed: 16 Mar 2021
Last updated: 13 Aug 2019



History and exam

Key diagnostic factors

  • abdominal pain
  • nausea and vomiting
  • anorexia
  • signs of hypovolemia

Other diagnostic factors

  • Grey-Turner sign
  • Cullen sign
  • Fox sign
  • Chvostek sign
  • hypotension
  • abdominal distention

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
  • systemic lupus erythematosus
  • Sjogren 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
  • CBC and differential
  • CRP
  • hematocrit
  • arterial blood gas
  • abdominal plain film
  • chest x-ray
  • transabdominal ultrasound
  • ratio of serum lipase:amylase

Investigations to consider

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

Emerging tests

  • urinary trypsinogen-2
  • serum interleukin-6
  • serum interleukin-8

Treatment algorithm


Associate Professor of Surgery

Department of Surgery

Indiana University




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 reviewersVIEW ALL

Assistant Professor of Medicine

Attending Physician and Director of Research

Columbia University Medical Center

New York



TAG declares that he has no competing interests.

Harvard Medical Faculty Physician

Division of Gastroenterology

Beth Israel Deaconess Medical Center




AM declares that he has no competing interests.

Consultant Hepatobiliary & Pancreatic Surgeon

Department of Surgery

North Manchester General Hospital




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


Department of Surgery

Division General Surgery

Shands Jacksonville Medical Center



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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