Acute pancreatitis

Acute pancreatitis most commonly presents as severe mid-epigastric or left upper quadrant pain that radiates to the back. Epigastric tenderness is typical.

Symptoms often include nausea and vomiting. A history of cholelithiasis or alcohol intake may be present.

Signs of hypovolemia (including decreased skin turgor, dry mucous membranes, hypotension, and sweating) are common. In more severe cases, the patient may be tachycardic and/or tachypneic.

In most patients who present with typical clinical signs, the diagnosis is confirmed by elevated serum lipase or amylase (>3 times upper limit of normal).

Initial treatment includes aggressive hydration with intravenous fluids, analgesia, and nutritional support, with early oral feeding favored if tolerated.

Treatment of severe acute pancreatitis includes support of end organ failure, most commonly of respiratory, renal, and circulatory systems. Local complications that may develop later include sterile or infected pancreatic necrosis and pseudocysts.

The presence of cholangitis in a patient with acute pancreatitis, characterized by an elevated bilirubin, warrants early endoscopic retrograde cholangiopancreatography (ERCP), typically within 24 hours from diagnosis.

Acute pancreatitis is an acute disorder of the exocrine pancreas associated with acinar cell injury and local and systemic inflammatory responses.[1]Nirula R. Chapter 9: Diseases of the pancreas. High yield surgery. Philadelphia, PA: Lippincott Williams & Wilkins; 2000. The severity of the disease varies: most patients will have mild disease with minimal pancreatic edema, and will recuperate fully within a few days; a minority of patients will have severe disease, characterized by a persistent systemic inflammatory response and/or multi-organ failure, with or without pancreatic/peripancreatic necrosis.