Acute pancreatitis - The essentials -

Acute pancreatitis is inflammation of the pancreas. The pancreas is "eaten" by the enzymes that it produces.

Causes: ususally gallstones, alkohol, hypertrigliceridemia, viral infections (coxackie, mumps - epidemic parotitis).

Diagnosis: abdominal pain and vomiting  associated with increase in serum amylase or lipase levels at least mare than three times upper limit of normal. Lipase levels remain increased for longer than amylase levels.

Acute pancreatitis is diagnosed when at least 2 of 3 criteria are present:

• typical abdominal pain, 

• raised enzyme levels, 

• appearances of pancreatitis on computer tomography.

Blog tests may reveal hypercalcemia and hypertrigliceridemia

Abdominal US may reveal gallstones.

Differential diagnoses: 

• Perforated peptic ulcer, 

• Myocardial infarction

• Cholecystitis.

Medical management

• Ringer lactat 2,5-4 l the first 24 h or enough to get a normal urine output 0.5-1ml/kg/hr.
• Antibiotics? Only if infection is clinically suspected or found.At present there is no indication for early antibiotics to prevent infection pancreatic necrosis.
• Pain relief (opioid) 
• Enter nutrition - nasogastric intubation.

Source: BMJ 2014;349:g4859 doi: 10.1136/bmj.g4859