Summary
Definition
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)
Treatment algorithm
Contributors
Authors
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
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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