Acute pancreatitis

When viewing this topic in a different language, you may notice some differences in the way the content is structured, but it still reflects the latest evidence-based guidance.

Last reviewed: 30 Sep 2025
Last updated: 24 Oct 2024

Summary

Definition

History and exam

Key diagnostic factors

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

Other diagnostic factors

  • signs of organ dysfunction
  • Grey-Turner sign
  • Cullen sign
  • Fox sign
  • abdominal distention
Full details

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
Full details

Diagnostic tests

1st tests to order

  • 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
Full details

Tests to consider

  • abdominal CT scan
  • magnetic resonance imaging/magnetic resonance cholangiopancreatography (MRI/MRCP)
  • endoscopic ultrasound (EUS)
Full details

Emerging tests

  • procalcitonin
Full details

Treatment algorithm

ACUTE

all patients

ONGOING

deteriorating or failing to improve

Contributors

Expert advisers

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

Declarações

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

Créditos aos pareceristas

Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.

Declarações

As afiliações e declarações dos pareceristas referem--se ao momento da revisão.

Referências

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

Principais artigos

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.Texto completo  Resumo

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.Texto completo  Resumo

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.Texto completo  Resumo

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

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.Texto completo  Resumo

Artigos de referência

Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
  • Acute pancreatitis images
  • Diagnósticos diferenciais

    • Peptic ulcer disease
    • Perforated viscus
    • Esophageal spasm
    Mais Diagnósticos diferenciais
  • Diretrizes

    • ​American College of Gastroenterology guidelines: management of acute pancreatitis​​​​​​
    • American College of Gastroenterology guidelines: management of acute pancreatitis
    Mais Diretrizes
  • Videos

    Venepuncture and phlebotomy: animated demonstration

    Radial artery puncture animated demonstration

    Mais vídeos
  • Folhetos informativos para os pacientes

    Pancreatitis, acute

    Pancreatic cancer

    Mais Folhetos informativos para os pacientes
  • padlock-lockedConectar-se ou assinar para acessar todo o BMJ Best Practice

O uso deste conteúdo está sujeito ao nosso aviso legal