2 learning resources available for this topic
Acute pancreatitis is inflammation of the pancreas presenting with acute-onset epigastric pain radiating to the back, nausea, and elevated pancreatic enzymes. It ranges from mild and self-limiting to severe necrotizing pancreatitis with multi-organ failure and high mortality.
The two most common causes — gallstones and alcohol — each trigger premature activation of pancreatic digestive enzymes within acinar cells, initiating autodigestion and a local then systemic inflammatory cascade. Trypsinogen activation is central to the pathophysiology. Severe cases progress to pancreatic necrosis, infected necrosis, and systemic inflammatory response syndrome (SIRS) with multi-organ dysfunction.
Diagnosis requires two of three criteria: characteristic abdominal pain, lipase or amylase ≥3× upper normal, or confirmatory imaging. The Revised Atlanta Classification stratifies severity. BISAP score helps predict severe disease. Gallstone pancreatitis requires cholecystectomy during the same hospitalization to prevent recurrence. Key management principles include aggressive IV fluid resuscitation, early enteral nutrition, and avoidance of antibiotics unless infected necrosis is confirmed.
Key imaging focus: Pancreatic enlargement, peripancreatic fluid, necrosis (non-enhancing areas), Balthazar grade
Common clinical reasoning questions about this topic
Acute pancreatitis requires two of three criteria: characteristic abdominal pain (epigastric, radiating to back), serum lipase or amylase ≥3 times upper limit of normal, or characteristic imaging findings on CT or MRI.
Gallstones and alcohol account for 70-80% of cases. Other causes include hypertriglyceridemia, medications (azathioprine, thiazides, valproate), ERCP, trauma, and autoimmune pancreatitis. Idiopathic pancreatitis accounts for 10-15%.
The Revised Atlanta Classification categorizes pancreatitis as mild (no organ failure, no local complications), moderately severe (transient organ failure <48h or local complications), or severe (persistent organ failure >48h). The BISAP score predicts severe disease.