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Acute pancreatitis

Last reviewed: 6 Nov 2023
Last updated: 17 Aug 2023



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


all patients


deteriorating or failing to improve



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



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


New York University School of Medicine



CTT declares that he has no competing interests.


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.


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



TAG declares that he has no competing interests.

Alan Moss, MD

Harvard Medical Faculty Physician

Division of Gastroenterology

Beth Israel Deaconess Medical Center




AM declares that he has no competing interests.

Derek O'Reilly, MD

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.

Eric Frykberg, MD


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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