Curriculum · Gastroenterology
Acute pancreatitis
What it is
Acute pancreatitis is sudden epigastric pain with a rise in pancreatic enzymes. It is classified in two ways, and both are used in management:
- Interstitial edematous or necrotizing
- Mild, moderate, or severe
Mild disease needs only supportive therapy. The severe and necrotizing end is where organ failure, infected necrosis and intervention come in. Repeated episodes of acute pancreatitis may result in chronic pancreatitis.
Causes and risk
Gallstone biliary obstruction and alcohol are the most common causes: gallstones are the most common cause worldwide, alcohol the second. The rest of the list:
- Idiopathic, Gallstones, Ethanol (alcohol), Trauma
- Steroids, Mumps and other infections or malignancy, Autoimmune, Scorpion stings and spider bites
- Hyperlipidemia and hypercalcaemia, ERCP, Drugs
Also: hypertriglyceridemia >11 mmol/L; drugs such as sulfonamides, estrogens, didanosine, valproic acid, thiazide diuretics, azathioprine/6-MP, pentamidine and furosemide; and cystic fibrosis in young people with pancreatitis. Bulimia nervosa is another way in: large fatty binges plus electrolyte disturbances trigger it, so a patient with known bulimia who suddenly has severe epigastric pain and vomiting should make you think of acute pancreatitis.