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Key Clinical Questions

  • image What are the criteria for the diagnosis of acute pancreatitis?

  • image What efforts should be made to determine the etiology during hospitalization, and what is the optimal timing of diagnostic and/or intervention studies in acute pancreatitis?

  • image What are the key components of early management?

  • image What is the management of late complications?

  • image When should consultation with gastroenterology, surgery, or interventional radiology be considered?

  • image When are specific interventions such as endoscopic retrograde cholangiopancreatography, fine-needle aspiration, or antibiotics indicated?


Acute pancreatitis is a common cause for hospitalization in the United States. Recent data from the National Center for Health Statistics have indicated a rising frequency of admissions for acute pancreatitis attributed to the increase in gallstone-related disease. Annually, more than 300,000 hospital admissions for acute pancreatitis present in the United States at a direct cost of more than $2 billion. Although acute pancreatitis is typically a mild, self-limited disease, a wide range of severity exists. Fifteen to twenty percent of patients experience a more severe form of disease with overall ­in-hospital mortality estimated to range between 2% and 5% of cases.

Risk factors for acute pancreatitis include both genetic susceptibility and environmental exposures. Genes involving mutation in the cystic fibrosis transmembrane conductance regulator, cationic trypsinogen gene (PRSS1), and secretory trypsin inhibitor (SPINK1) have been identified in patients with recurrent acute pancreatitis. Other patient-related factors such as obesity have also been demonstrated to be associated with increased severity of disease.

The most common etiology for acute pancreatitis is now ­gallstone-related disease, followed by alcohol and idiopathic pancreatitis (Table 157-1). ­Additional etiologies include metabolic derangements (­hypercalcemia, hypertriglyceridemia) and medications (Table 157-2). Less common etiologies include autoimmune and hereditary forms of pancreatitis. Whether pancreas divisum itself is a cause for acute pancreatitis remains controversial.

TABLE 157-1Etiologies of Acute Pancreatitis
TABLE 157-2Drug-Induced Pancreatitis

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