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
其他诊断因素
- signs of organ dysfunction
- Grey-Turner sign
- Cullen sign
- Fox sign
- abdominal distention
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
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
需考虑的检查
- abdominal CT scan
- magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP)
- endoscopic ultrasound (EUS)
新兴检查
- procalcitonin
治疗流程
all patients
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
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.
鉴别诊断
- Peptic ulcer disease
- Perforated viscus
- Esophageal spasm
更多 鉴别诊断指南
- American College of Gastroenterology guidelines: management of acute pancreatitis
- American College of Gastroenterology guidelines: management of acute pancreatitis
更多 指南Videos
Venepuncture and phlebotomy: animated demonstration
Radial artery puncture animated demonstration
更多 操作视频患者教育信息
Pancreatitis, acute
Pancreatic cancer
更多 患者教育信息登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容
内容使用需遵循免责声明