Acute pancreatitis

Acute pancreatitis typically presents with severe sudden-onset mid-epigastric or left upper quadrant abdominal pain, which often radiates to the back. Nausea and vomiting is seen in 80% of patients.

The diagnosis is confirmed in most patients by elevated serum lipase or amylase (>3 times upper limit of normal). Contrast-enhanced computed tomography (CECT) is only required where there is diagnostic doubt or a failure to improve within 72 to 96 hours from onset of symptoms.

The most common causes are gallstones and excessive alcohol consumption.

Initial treatment focuses on resuscitation with intravenous fluids, analgesia, and nutritional support, with early oral feeding favoured if tolerated.

In severe cases, treatment may include support for organ failure; drainage of pancreatic necrosis; and antibiotic therapy ± surgical necrosectomy for infected necrosis.

Approximately 80% of cases are mild but in severe cases the mortality rate is as high as 30%. The pattern of deaths is biphasic, with early mortality (<2 weeks) related to systemic inflammatory response syndrome (SIRS)/multi-organ failure and later deaths (>2 weeks) due to local complications including infected necrosis and pseudocysts.

A disorder of the exocrine pancreas, and is associated with acinar cell injury with 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 oedema, and will recuperate fully within a few days; a minority of patients will have severe disease, characterised by a persistent systemic inflammatory response and/or multi-organ failure, with or without pancreatic/peripancreatic necrosis.