21st April 2024

Acute Pancreatitis

Background

Acute pancreatitis typically presents as epigastric pain and, more often than not, is associated with nausea and vomiting. The two most common causes are alcohol and gallstones. Diagnosis can be confirmed by the presence of at least two of the following three criteria: upper abdominal pain (left upper quadrant or epigastric), serum amylase >3x upper limit of normal, and characteristic findings on imaging (CT is often the modality of choice). Note imaging only needs to be requested if there is diagnostic doubt. Once a diagnosis of acute pancreatitis is made, an abdominal ultrasound should be requested to look for gallstones. Management is initially supportive (fluids, analgesia, antiemetics, and nutrition).

Investigation

Serum amylase, abdominal ultrasound and CT are used in diagnosis. CT is often used in severe cases to look for complications such as necrosis and pseudocyst formation.

Management

This is largely supportive, with IV fluids and anti-emetics. Surgical intervention can be used to drain pseudocysts, and necrosectomy can be used for necrotic tissue.