Clinical Review

Acute pancreatitis

BMJ 2014; 349 doi: http://dx.doi.org/10.1136/bmj.g4859 (Published 12 August 2014) Cite this as: BMJ 2014;349:g4859
  1. C D Johnson, professor of surgical sciences1,
  2. M G Besselink, hepatopancreatobiliary surgeon2,
  3. R Carter, consultant pancreatic surgeon3
  1. 1University Surgery, University Hospital Southampton, SO16 6YD, UK
  2. 2Dutch Pancreatitis Study Group, Academic Medical Center Amsterdam, Netherlands
  3. 3West of Scotland Pancreatic Unit, Glasgow Royal infirmary, Glasgow, UK
  1. Correspondence to: C D Johnson cdj{at}soton.ac.uk

Summary points

  • All patients with acute pancreatitis should have liver function tests and abdominal ultrasonography within 24 hours of admission to look for gallstones

  • Severe acute pancreatitis is characterised by persistent (>48 hours) organ failure; these patients have a >30% mortality rate

  • If symptoms persist for more than seven days computed tomography is required to assess pancreatic and peripancreatic necrosis

  • Initial management includes adequate fluid resuscitation and supplemental oxygen

  • If gallstones are found, definitive treatment (by cholecystectomy or sphincterotomy) should be given within two weeks of resolution of symptoms

  • Necrotising pancreatitis should be managed by a specialist team including surgeons, endoscopists, interventional radiologists, and intensivists

Acute pancreatitis is a common cause of emergency admission to hospital. Most hospitals in the United Kingdom serving a population of 300 000-400 000 people admit about 100 cases each year. We review up to date evidence for the assessment, diagnosis, and management of acute pancreatitis.

Sources and selection criteria

We have drawn heavily on three recent evidence based guidelines1 2 3 that we helped to write and we reviewed the Cochrane Library for relevant clinical trials. In December 2013 we again reviewed the Cochrane Library to identify any systematic review or update relevant to acute pancreatitis.

What is acute pancreatitis?

Acute pancreatitis is inflammation of the pancreas; it is sometimes associated with a systemic inflammatory response that can impair the function of other organs or systems. The inflammation may settle spontaneously or may progress to necrosis of the pancreas or surrounding fatty tissue. The distant organ or system dysfunction may resolve or may progress to organ failure. Thus there is a wide spectrum of disease from mild (80%), where patients recover within a few days, to severe (20%) with prolonged hospital stay, the need for critical care support, and a 15-20% risk of death.3 If patients have organ failure during the first week in …

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