Clinical Case Database / Category: Patient Management

Management of acute pancreatitis

Publication details

Heather M Sowden BSc MBChB, Sonia Littlewood MBChB, MRCS
Foundation Years Journal, volume 4, issue 1, p.38 (123Doc Education, London, January 2010)


Acute pancreatitis (AP) is an inflammatory condition of the pancreatic gland whereby pancreatic enzymes autodigest the pancreas. Although the exact mechanisms by which this process occurs is unknown, the presence of gallstones and excessive alcohol consumption are responsible for approximately 75% of attacks in the UK. Individuals typically present with acute epigastric pain that radiates through to the back, nausea and vomiting are also prominent features. The diagnosis is confirmed by a raised serum amylase, however, if individuals present more than 3 days after the onset of pain, the amylase may be normal and serum lipase measurements may be more useful. The majority of people will have mild self-limiting disease that requires supportive care only. However, of those with AP approximately 20% go on to have a severe attack characterised by the systemic inflammatory response syndrome (SIRS), and multi-organ dysfunction (MOD). Identifying early those who are likely to have a severe attack has been the driving force behind the development of scoring systems aimed to predict early those who will develop a serious attack. Those with both local and systemic complications will need to receive their care in a high dependency or intensive care unit environment and ideally be managed by multidisciplinary teams. Mortality from AP has a bimodal distribution with approximately half of the deaths occurring in the first 14 days from SIRS and MOD, which fails to respond to treatment. The second peak occurs at 3 months with MOD secondary to sepsis from infected pancreatic necrosis.

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Heather M Sowden BSc MBChB

FY1 in General Surgery, Dewsbury District Hospital, West Yorkshire

Sonia Littlewood MBChB, MRCS

SpR in General Surgery (Colorectal), Dewsbury District Hospital, West Yorkshire


1. Browse NL, Black J, Burnand KG, Thomas WEG (eds) (2005) Acute Pancreatitis, Browse's introduction to symptoms and signs of surgical disease, 4th edn. New York: Oxford University Press, pp. 399–400.
2. McKay CJ, Evans S, Sinclair M, et al. (1999) High early mortality rate from acute pancreatitis in Scotland, 1984–1995. Br J Surg 86:1302–1305.
3. Toh SK, Phillips S, Johnson CD (2000) A prospective audit against national standards of the presentation and management of acute pancreatitis in the South of England. Gut 46:239–243.
4. UK guidelines for the management of acute pancreatitis. UK working party on acute pancreatitis. Gut 2005, 54:1–9.
5. Matull WR, Pereira SP, O'Donohue JW (2006) Biochemical markers of acute pancreatitis. J Clin Pathol 59:340–344.
6. Frossard JL, Steer ML, Pastor CM (2008) Acute pancreatitis. Lancet 371:143–152.
7. Sternby B, O'Brien JF, Zinsmeister AR, DiMagno EP (1996) What is the best biochemical test to diagnose acute pancreatitis? A prospective clinical study. Mayo Clinic Proc 71:1138–1144.
8. Wilson C, Heath DI, Imrie CW (1990) Prediction of outcome in acute pancreatitis: a comparative study of APACHE II, clinical assessment and multiple factor scoring systems. Br J Surg 77:1260–1264.
9. Lund H, Tonnensen H, Tonnensen MH, et al. (2006) Long-term recurrence and death rates after acute pancreatitis. Scand J Gastroenterol 41:234–238.
10. Berry AR, Taylor TV, Davies GC (1981) Pulmonary functions and fibrinogen metabolism in acute pancreatitis. Br J Surg 68:870—873.
11. McMahon MJ, Playforth MJ, Pickford IR (1980) A comparative study of methods for the prediction of severity of attacks of acute pancreatitis. Br J Surg 67:22–25.
12. Ranson JH, Rifkind KM, Roses DF, et al. (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139:69–81.
13. Imrie CW (1997) Classification of acute pancreatitis and the role of prognostic factors in assessing severity of disease. Schweiz Med Wochenschr
14. Imrie CW (2003) Prognostic indicators in acute pancreatitis. Can J Gastroenterol 17:325–328.
15. Knaus WA (2002) APACHE 1978–2001: the development of a quality assurance system based on prognosis: milestones and personal reflections. Arch Surg 137:37–41.
16. Knaus WA, Draper EA, Wagner DP, et al. (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818—829.
17. Buter A, Imrie CW, Carter CR, et al. (2002) Dynamic nature of early organ dysfunction determines outcome in acute pancreatitis. Br J Surg 89:298–302.
18. Martinez J, Johnson CD, Sanchez-Paya J, et al. (2006) Obesity is a definitive risk factor of severity and mortality in acute pancreatitis: an updated metaanalysis. Pancreatology 6:206-–209.
19. Windsor AC, Kanwar S, Li AG, et al. (1998) Compared with parenteral nutrition, enteral feeding attenuates the acute phase response and improves disease severity in acute pancreatitis. Gut 42:431–435.
20. Marik PE, Zaloga GP (2004) Meta-analysis of parenteral nutrition versus enteral nutrition in patients with acute pancreatitis. BMJ 328:1407–1412.
21. Eatock FC, Chong P, Menezes N, et al. (2005) A randomised study of early nasogastric versus nasojejunal feeding in acute severe pancreatitis. Am J Gastroenterol 100:432–439.
22. Eatock FC, Brombacher GD, Steven A, et al. (2000) Nasogastric feeding in severe acute pancreatitis may be practical and safe. Int J Pancreatol 28:23–29.
23. Isenmann R, Runzi M, Kron M, et al. (2004) Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology 126:997–1004.


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