Acute pancreatitis resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]

Definition

It is an acute inflammation of the pancreas characterized by elevated pancreatic enzymes and severe abdominal pain.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Acute pancreatitis from any cause may be life-threatening especially if it progresses to necrotizing pancreatitis. However, in last several years it has come down due to advances in diagnosis and treatment strategies.

Common Causes

  • Gallstones
  • Alcohol
  • Smoking[1]
  • Pancreatic tumor[2]
  • Medication such as 5-Mercapto-purine, azathioprine, 5-DDI[4]
  • Hypertriglyceridemia
  • Post - ERCP
  • Metabolic - Hypercalcemia and hyperphosphatemia.
  • Infections
  • Toxins such as venom of brown recluse spider, certain arachnids etc.
  • Pregnancy
  • Idiopathic
  • Ischaemic necrosis of pancreas from vascular sources such as vasculitis and atherosclerosis.

Management

 
 
 
 
 
 
 
 
Acute Pancreatitis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
H/o severe abdominal pain, breathing difficulty, hypotension, vomiting, fever, cullen's sign, grey turner's sign
 
 
 
 
 
Labs - Sr. Amylase, Sr Lipase, Sr Triglycerides, Abdominal USG, CBC, CECT, MRI
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Diagnostic criteria: Any 2 out of 3
Abdominal pain consistent with disease
serum amylase or lipase values > 3 times normal
consistent findings from abdominal imaging
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Risk Stratification
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Low risk
 
 
 
 
 
High risk
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
General medical ward
 
 
 
 
 
ICU
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Inititate supportive care
Aggressive fluid resusication with 250-500mL Ringers Lactate per Hr during first 12-24 hours.In sever cases give fluid bolus.
Mild cases - oral liquid feeds. In moderate to severe cases enteral feeds, nasogastric or nasojejunal feeds are acceptable.
 
 
 
 
 
 
CT scan
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Provide adequate analgesia
 
 
 
 
 
 
Pancreatic necrosis
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Stones??
 
Other causes, treat as per cause.
 
 
No
 
Yes
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Surical consult. Emergency cholecystectomy or ERCP within 24 Hrs of admission
 
Assess in 1 week.
 
 
 
 
 
 
SIRS/Organ failure??
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Tolerating oral feeds.
 
 
 
Not tolerating oral feed.
 
 
If yes, surgical consultation.Think about CT guided percutaneous aspiration & culture.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Recovery.
 
 
 
Add nutritional support. COnsider CT scan.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Lack of improvement/Worsening of clinical status.
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

References


Template:WikiDoc Sources

  1. ↑ Rebours, V.; Vullierme, MP.; Hentic, O.; Maire, F.; Hammel, P.; Ruszniewski, P.; Lévy, P. (2012). "Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship". Pancreas. 41 (8): 1219–24. doi:10.1097/MPA.0b013e31825de97d. PMID 23086245. Unknown parameter |month= ignored (help)
  2. ↑ Köhler, H.; Lankisch, PG. (1987). "Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma". Pancreas. 2 (1): 117–9. PMID 2437571.
  3. ↑ Bleichner, JP.; Guillou, YM.; Martin, L.; Seguin, P.; Mallédant, Y. (1998). "-Pancreatitis after blunt injuries to the abdomen-". Ann Fr Anesth Reanim. 17 (3): 250–3. PMID 9750738.
  4. ↑ Yi, GC.; Yoon, KH.; Hwang, JB. (2012). "Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease". Pediatr Gastroenterol Hepatol Nutr. 15 (4): 272–5. doi:10.5223/pghn.2012.15.4.272. PMID 24010098. Unknown parameter |month= ignored (help)
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