Clinical Review

Acute pancreatitis

BMJ 2006; 332 doi: http://dx.doi.org/10.1136/bmj.332.7549.1072 (Published 04 May 2006) Cite this as: BMJ 2006;332:1072
  1. Andrew Kingsnorth, professor of surgery ([email protected])1,
  2. Derek O'Reilly, specialist registrar2
  1. 1 Derriford Hospital, Plymouth PL6 8DH
  2. 2 Department of Surgery, University Hospital Aintree, Liverpool
  1. Correspondence to: A Kingsnorth
  • Accepted 28 March 2006

Introduction

Acute pancreatitis is a potentially lethal disease that is increasing in incidence. The high mortality associated with acute pancreatitis has improved as a result of a greater understanding of the natural history of acute pancreatitis and recent advances in critical care. Optimal management requires a greater willingness to consider the diagnosis of acute pancreatitis, stratification of severity, and adequate fluid resuscitation. Here, we review who gets acute pancreatitis and how to deal with those patients in whom the cause remains unclear. We also examine the current controversies in acute pancreatitis: how to deliver nutritional support, what role exists for antibiotic prophylaxis, when to do a computed tomography scan, and the role of early endoscopic retrograde cholangiopancreatography (ERCP).

Is acute pancreatitis becoming more common?

Incidence rates vary from 5.4 per 100 000 population per year to 79.8 per 100 000 per year. Variation is due to different diagnostic criteria, geographical factors, and changes over time. One constant, however, is an apparent increase in the incidence of acute pancreatitis in the past 40 years. For example, the incidence in Scotland has risen from 9.4 per 100 000 per year in 1968-80 to 41.9 per 100 000 per year in 1995.1 This rise in incidence may be due to improved diagnostic capability during this period but may also reflect a true increase due to a greater prevalence of risk factors such as increased alcohol consumption.

How does acute pancreatitis present?

Abdominal pain, usually located in the epigastrium, is the cardinal symptom of acute pancreatitis. It typically increases in severity over a few hours before reaching a plateau that may last for several days. Continuance of the pain beyond this time is associated with the development of local complications, such as acute fluid collections, pseudocysts, and necrosis. Nausea and vomiting are associated symptoms. Abdominal signs may vary from mild tenderness to generalised peritonitis. Blue-grey …

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