Skip to main content
SpringerLink
Log in

Acute Pancreatitis

  • Chapter
  • First Online:
Common Problems in Acute Care Surgery

Abstract

Acute pancreatitis presents with rapid onset of severe epigastric pain. Localized pancreatic inflammation induces a spectrum of clinical significance. Most cases are self-limited, whereas a minority may produce systemic effects with distant organ failure. Gallstones and alcohol ingestion are the most common etiologies of pancreatitis, although medications, infection, and metabolic causes are less frequent. The pathophysiology is thought to originate in the acinar cells with co-localization of pancreatic zymogens and lysozymes in the cytoplasm. The resulting inappropriate activation leads to acinar cell damage, followed by a significant leukocyte infiltration which propagates the cycle of inflammation and injury.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 109.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Peery AF, et al. Burden of gastrointestinal, liver, and pancreatic diseases in the United States. Gastroenterology. 2015;149(7):1731–41. e3.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. 2006;354(20):2142–50.

    Article  PubMed  Google Scholar 

  3. Peery AF, et al. Burden of gastrointestinal disease in the United States: 2012 update. Gastroenterology. 2012:143(5):1179–87 e1-3.

    Google Scholar 

  4. Ranson JH, et al. Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet. 1974;139(1):69–81.

    CAS  PubMed  Google Scholar 

  5. Banks PA, Freeman ML, Practice Parameters Committee of the American College. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.

    Article  PubMed  Google Scholar 

  6. De Campos T, et al. Morbimortality indicators in severe acute pancreatitis. JOP. 2008;9(6):690–7.

    PubMed  Google Scholar 

  7. Barlow AD, et al. The role of magnetic resonance cholangiopancreatography in the management of acute gallstone pancreatitis. Ann R Coll Surg Engl. 2013;95(7):503–6.

    Article  CAS  PubMed  Google Scholar 

  8. Duncan CB, Riall TS. Evidence-based current surgical practice: calculous gallbladder disease. J Gastrointest Surg. 2012;16(11):2011–25.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Yang AL, et al. Epidemiology of alcohol-related liver and pancreatic disease in the United States. Arch Intern Med. 2008;168(6):649–56.

    Article  PubMed  Google Scholar 

  10. Kume K, et al. Alcohol consumption and the risk for developing pancreatitis: a case-control study in Japan. Pancreas. 2015;44(1):53–8.

    Article  CAS  PubMed  Google Scholar 

  11. Maleth J, et al. Alcohol disrupts levels and function of the cystic fibrosis transmembrane conductance regulator to promote development of pancreatitis. Gastroenterology. 2015;148(2):427–39. e16.

    Article  CAS  PubMed  Google Scholar 

  12. Patman G. Pancreatitis: mislocalization of CFTR by alcohol promotes pancreatitis. Nat Rev Gastroenterol Hepatol. 2015;12(1):2.

    Article  PubMed  Google Scholar 

  13. Cho JH, Kim TN, Kim SB. Comparison of clinical course and outcome of acute pancreatitis according to the two main etiologies: alcohol and gallstone. BMC Gastroenterol. 2015;15:87.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Yadav D, Pitchumoni CS. Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol. 2003;36(1):54–62.

    Article  CAS  PubMed  Google Scholar 

  15. Preiss D, et al. Lipid-modifying therapies and risk of pancreatitis: a meta-analysis. JAMA. 2012;308(8):804–11.

    Article  CAS  PubMed  Google Scholar 

  16. Murphy MJ, et al. HYpertriglyceridemia and acute pancreatitis. JAMA Intern Med. 2013;173(2):162–4.

    Article  CAS  PubMed  Google Scholar 

  17. Mariani A, et al. Outcome of endotherapy for pancreas divisum in patients with acute recurrent pancreatitis. World J Gastroenterol. 2014;20(46):17468–75.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wang DB, et al. Pancreatitis in patients with pancreas divisum: imaging features at MRI and MRCP. World J Gastroenterol. 2013;19(30):4907–16.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Wong LL, Tsai HH. Prevention of post-ERCP pancreatitis. World J Gastrointest Pathophysiol. 2014;5(1):1–10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Katsinelos P, et al. Predictive factors for post-ERCP pancreatitis: a large-scale single expertized endoscopist study. Surg Laparosc Endosc Percutan Tech. 2014;24(6):512–6.

    PubMed  Google Scholar 

  21. Baron TH, Irani S. Prevention of post-ERCP pancreatitis. Minerva Med. 2014;105(2):129–36.

    CAS  PubMed  Google Scholar 

  22. Kerdsirichairat T, et al. Urgent ERCP with pancreatic stent placement or replacement for salvage of post-ERCP pancreatitis. Endoscopy. 2014;46(12):1085–94.

    Article  PubMed  Google Scholar 

  23. Dubravcsik Z, et al. Early ERCP and biliary sphincterotomy with or without small-caliber pancreatic stent insertion in patients with acute biliary pancreatitis: better overall outcome with adequate pancreatic drainage. Scand J Gastroenterol. 2012;47(6):729–36.

    Article  CAS  PubMed  Google Scholar 

  24. Badalov N, et al. Drug-induced acute pancreatitis: an evidence-based review. Clin Gastroenterol Hepatol. 2007;5(6):648–61.e3.

    Google Scholar 

  25. Whitcomb DC, et al. Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet. 1996;14(2):141–5.

    Article  CAS  PubMed  Google Scholar 

  26. Whitcomb DC, et al. A gene for hereditary pancreatitis maps to chromosome 7q35. Gastroenterology. 1996;110(6):1975–80.

    Article  CAS  PubMed  Google Scholar 

  27. Ahmad SA, et al. Chronic pancreatitis: recent advances and ongoing challenges. Curr Probl Surg. 2006;43(3):135–238.

    Google Scholar 

  28. Sandhu B, et al. Presence of SPINK-1 variant alters the course of chronic pancreatitis. J Gastroenterol Hepatol. 2011;26(6):965–9.

    Article  CAS  PubMed  Google Scholar 

  29. Deng YY, et al. Etiology, clinical features and management of acute recurrent pancreatitis. J Dig Dis. 2014;15(10):570–7.

    Article  PubMed  Google Scholar 

  30. Banks PA, et al. Classification of acute pancreatitis–2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.

    Article  PubMed  Google Scholar 

  31. Yadav D, Agarwal N, Pitchumoni CS. A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol. 2002;97(6):1309–18.

    Article  CAS  PubMed  Google Scholar 

  32. Hameed AM, Lam VW, Pleass HC. Significant elevations of serum lipase not caused by pancreatitis: a systematic review. HPB (Oxford). 2015;17(2):99–112.

    Article  Google Scholar 

  33. Batra HS, et al. Comparative study of serum amylase and lipase in acute pancreatitis patients. Indian J Clin Biochem. 2015;30(2):230–3.

    Article  CAS  PubMed  Google Scholar 

  34. Yang RW, et al. Lipase and pancreatic amylase activities in diagnosis of acute pancreatitis in patients with hyperamylasemia. Hepatobiliary Pancreat Dis Int. 2005;4(4):600–3.

    CAS  PubMed  Google Scholar 

  35. Keim V, et al. A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain. Pancreas. 1998;16(1):45–9.

    Article  CAS  PubMed  Google Scholar 

  36. Rana SS, et al. Can early endoscopic ultrasound predict pancreatic necrosis in acute pancreatitis? Ann Gastroenterol. 2014;27(4):404–8.

    PubMed  PubMed Central  Google Scholar 

  37. Andari R, Modiri A, Makipour K. Endoscopic ultrasound should be performed before endoscopic retrograde cholangiopancreatography in all patients with mild acute gallstone pancreatitis. Pancreas. 2014;43(1):147–8.

    Article  PubMed  Google Scholar 

  38. Sheu Y, et al. The revised Atlanta classification for acute pancreatitis: a CT imaging guide for radiologists. Emerg Radiol. 2012;19(3):237–43.

    Article  CAS  PubMed  Google Scholar 

  39. Nuutinen P, Kivisaari L, Schroder T. Contrast-enhanced computed tomography and microangiography of the pancreas in acute human hemorrhagic/necrotizing pancreatitis. Pancreas. 1988;3(1):53–60.

    Article  CAS  PubMed  Google Scholar 

  40. Spanier BW, Bruno MJ. Use of early CT scanning in patients with acute pancreatitis. Radiology. 2011;260(2):606.

    Article  PubMed  Google Scholar 

  41. Calculli L, et al. Imaging techniques for acute necrotizing pancreatitis: multidetector computed tomography. JOP. 2006;7(1):104–9.

    PubMed  Google Scholar 

  42. Bollen TL, et al. A comparative evaluation of radiologic and clinical scoring systems in the early prediction of severity in acute pancreatitis. Am J Gastroenterol. 2012;107(4):612–9.

    Article  PubMed  Google Scholar 

  43. Shinagare AB, et al. Use of CT and MRI in emergency department patients with acute pancreatitis. Abdom Imaging. 2015;40(2):272–7.

    Article  PubMed  Google Scholar 

  44. Chandrasekaran P, et al. Prospective comparison of long term outcomes in patients with severe acute pancreatitis managed by operative and non operative measures. Pancreatology. 2015;15(5):478–84.

    Article  PubMed  Google Scholar 

  45. Thai TC, Riherd DM, Rust KR. MRI manifestations of pancreatic disease, especially pancreatitis, in the pediatric population. AJR Am J Roentgenol. 2013;201(6):W877–92.

    Article  PubMed  Google Scholar 

  46. Schepers NJ, et al. Early management of acute pancreatitis. Best Pract Res Clin Gastroenterol. 2013;27(5):727–43.

    Article  PubMed  Google Scholar 

  47. Bradley III EL. A clinically based classification system for acute pancreatitis. Summary of the international symposium on acute pancreatitis, Atlanta, GA, September 11 through 13, 1992. Arch Surg. 1993;128(5):586–90.

    Article  PubMed  Google Scholar 

  48. Bollen TL, et al. The Atlanta Classification of acute pancreatitis revisited. Br J Surg. 2008;95(1):6–21.

    Article  CAS  PubMed  Google Scholar 

  49. Singh VK, et al. An assessment of the severity of interstitial pancreatitis. Clin Gastroenterol Hepatol. 2011;9(12):1098–103.

    Article  PubMed  Google Scholar 

  50. van Santvoort HC, et al. A conservative and minimally invasive approach to necrotizing pancreatitis improves outcome. Gastroenterology. 2011;141(4):1254–63.

    Article  PubMed  Google Scholar 

  51. Banks PA, et al. CT-guided aspiration of suspected pancreatic infection. Int J Pancreatol. 1995;18(3):265–70.

    CAS  PubMed  Google Scholar 

  52. Kuo DC, et al. Acute pancreatitis: what’s the score? J Emerg Med. 2015;48(6):762–70.

    Article  PubMed  Google Scholar 

  53. Andersson B, et al. Prediction of severe acute pancreatitis at admission to hospital using artificial neural networks. Pancreatology. 2011;11(3):328–35.

    Article  PubMed  Google Scholar 

  54. Rau BM. Predicting severity of acute pancreatitis. Curr Gastroenterol Rep. 2007;9(2):107–15.

    Article  PubMed  Google Scholar 

  55. Ranson JH, et al. Objective early identification of severe acute pancreatitis. Am J Gastroenterol. 1974;61(6):443–51.

    CAS  PubMed  Google Scholar 

  56. Khanna AK, et al. Comparison of ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in predicting severity, organ failure, pancreatic necrosis, and mortality in acute pancreatitis. HPB Surg. 2013;2013:367581.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Park JY, et al. Bedside index for severity in acute pancreatitis: comparison with other scoring systems in predicting severity and organ failure. Hepatobiliary Pancreat Dis Int. 2013;12(6):645–50.

    Article  PubMed  Google Scholar 

  58. Bota S, et al. Predictive factors for severe evolution in acute pancreatitis and a new score for predicting a severe outcome. Ann Gastroenterol. 2013;26(2):156–62.

    PubMed  PubMed Central  Google Scholar 

  59. Wang S, et al. The ability of current scoring systems in differentiating transient and persistent organ failure in patients with acute pancreatitis. J Crit Care. 2014;29(4):693 e7-11.

    Google Scholar 

  60. De Campos T, et al. Classification of acute pancreatitis. Rev Col Bras Cir. 2013;40(2):164–8.

    Article  PubMed  Google Scholar 

  61. Mason JM, et al. The performance of organ dysfunction scores for the early prediction and management of severity in acute pancreatitis: an exploratory phase diagnostic study. Pancreas. 2010;39(7):1104–8.

    Article  PubMed  Google Scholar 

  62. Baillargeon J-D, et al. Hemoconcentration as an early risk factor for necrotizing pancreatitis. Am J Gastroenterol. 1998;93(11):2130–4.

    Article  CAS  PubMed  Google Scholar 

  63. Wu B, Hwang J, Gardner T. Early fluid resuscitation strategies in acute pancreatitis: a randomized-controlled trial. Clin Gastroenterol Hepatol. 2011;9:710–7.

    Article  PubMed  Google Scholar 

  64. de-Madaria E, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a Prospective Cohort Study. Am J Gastroenterol. 2011;106(10):1843–50.

    Google Scholar 

  65. Mofidi R, et al. Association between early systemic inflammatory response, severity of multiorgan dysfunction and death in acute pancreatitis. Br J Surg. 2006;93(6):738–44.

    Article  CAS  PubMed  Google Scholar 

  66. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101(10):2379–400.

    Article  PubMed  Google Scholar 

  67. Jacobson BC, et al. A prospective, randomized trial of clear liquids versus low-fat solid diet as the initial meal in mild acute pancreatitis. Clin Gastroenterol Hepatol. 2007;5(8):946–51.

    Article  PubMed  PubMed Central  Google Scholar 

  68. Eckerwall GE, et al. Immediate oral feeding in patients with mild acute pancreatitis is safe and may accelerate recovery—a randomized clinical study. Clin Nutr. 2007;26(6):758–63.

    Article  PubMed  Google Scholar 

  69. Kumar A, et al. Early enteral nutrition in severe acute pancreatitis: a prospective randomized controlled trial comparing nasojejunal and nasogastric routes. J Clin Gastroenterol. 2006;40(5):431–4.

    Article  CAS  PubMed  Google Scholar 

  70. Singh N, et al. Evaluation of early enteral feeding through nasogastric and nasojejunal tube in severe acute pancreatitis: a noninferiority randomized controlled trial. Pancreas. 2012;41(1):153–9.

    Article  PubMed  Google Scholar 

  71. Eatock FC, et al. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. 2005;100(2):432–9.

    Article  CAS  PubMed  Google Scholar 

  72. Dellinger EP, et al. Early antibiotic treatment for severe acute necrotizing pancreatitis: a randomized, double-blind. Placebo-controlled study. Ann Surg. 2007;245(5):674–83.

    Article  PubMed  PubMed Central  Google Scholar 

  73. Isenmann R, et al. Prophylactic antibiotic treatment in patients with predicted severe acute pancreatitis: a placebo-controlled, double-blind trial. Gastroenterology. 2004;126(4):997–1004.

    Article  CAS  PubMed  Google Scholar 

  74. Villatoro E, Mulla M, Larvin M. Antibiotic therapy for prophylaxis against infection of pancreatic necrosis in acute pancreatitis. Cochrane Database Syst Rev. 2010;5(1):CD002941.

    Google Scholar 

  75. Fogel EL, Sherman S. ERCP for gallstone pancreatitis. N Engl J Med. 2014;370(2):150–7.

    Article  CAS  PubMed  Google Scholar 

  76. Moreau JA, et al. Gallstone pancreatitis and the effect of cholecystectomy: a population-based cohort study. Mayo Clin Proc. 1988;63(5):466–73.

    Article  CAS  PubMed  Google Scholar 

  77. Horvath KD, et al. A technique for laparoscopic-assisted percutaneous drainage of infected pancreatic necrosis and pancreatic abscess. Surg Endosc. 2001;15(10):1221–5.

    Article  CAS  PubMed  Google Scholar 

  78. Freeman ML, et al. Interventions for necrotizing pancreatitis: summary of a multidisciplinary consensus conference. Pancreas. 2012;41(8):1176–94.

    Article  PubMed  Google Scholar 

  79. van Santvoort HC, et al. A step-up approach or open necrosectomy for necrotizing pancreatitis. N Engl J Med. 2010;362(16):1491–502.

    Article  PubMed  Google Scholar 

  80. Seifert H, et al. Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD study). Gut. 2009;58(9):1260–6.

    Article  CAS  PubMed  Google Scholar 

  81. Gardner TB, et al. Direct endoscopic necrosectomy for the treatment of walled-off pancreatic necrosis: results from a multicenter US series. Gastrointest Endosc. 2011;73(4):718–26.

    Article  PubMed  Google Scholar 

  82. Lenhart DK, Balthazar EJ. MDCT of acute mild (Nonnecrotizing) pancreatitis: abdominal complications and fate of fluid collections. Am J Roentgenol. 2008;190(3):643–9.

    Article  Google Scholar 

  83. Varadarajulu S, et al. Predictors of outcome in pancreatic duct disruption managed by endoscopic transpapillary stent placement. Gastrointest Endosc. 2005;61(4):568–75.

    Article  PubMed  Google Scholar 

  84. Varadarajulu S, et al. Prospective randomized trial comparing EUS and EGD for transmural drainage of pancreatic pseudocysts (with videos). Gastrointest Endosc. 2008;68(6):1102–11.

    Article  PubMed  Google Scholar 

  85. Liu C, et al. Life-threatening complications of acute pancreatitis. Intensive Care Med. 2015;41(6):1145–6.

    Article  PubMed  Google Scholar 

  86. Aswani Y, Hira P. Venous complications of pancreatitis: a review. JOP. 2015;16(1):20–4.

    PubMed  Google Scholar 

  87. Singh VK, et al. Early systemic inflammatory response syndrome is associated with severe acute pancreatitis. Clin Gastroenterol Hepatol. 2009;7(11):1247–51.

    Article  PubMed  Google Scholar 

  88. Cai DM, et al. Diagnostic value of contrast enhanced ultrasound for splenic artery complications following acute pancreatitis. World J Gastroenterol. 2014;20(4):1088–94.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Upchurch E. Local complications of acute pancreatitis. Br J Hosp Med (Lond). 2014;75(12):698–702.

    Article  Google Scholar 

  90. Brown LA, et al. A systematic review of the extra-pancreatic infectious complications in acute pancreatitis. Pancreatology. 2014;14(6):436–43.

    Article  PubMed  Google Scholar 

  91. Callery MP, et al. A prospectively validated clinical risk score accurately predicts pancreatic fistula after pancreatoduodenectomy. J Am Coll Surg. 2013;216(1):1–14.

    Article  PubMed  Google Scholar 

  92. Raza SS, et al. Spontaneous pancreatic pseudocyst-portal vein fistula: a rare and potentially life-threatening complication of pancreatitis. Ann R Coll Surg Engl. 2013;95(1):e7–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, University of Texas Health Sciences Center at Houston, 5656 Kelley St Suite 30S62008, Houston, TX, 77026, USA

    Curtis J. Wray & Tien C. Ko

Authors
  1. Curtis J. Wray
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Tien C. Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Curtis J. Wray .

Editor information

Editors and Affiliations

  1. Department of Surgery, The University of Texas McGovern Medical School - Houston, Houston, Texas, USA

    Laura J. Moore

  2. General Surgery and Trauma Ben Taub Hospital, Houston, Texas, USA

    S. Rob Todd

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Wray, C.J., Ko, T.C. (2017). Acute Pancreatitis. In: Moore, L., Todd, S. (eds) Common Problems in Acute Care Surgery. Springer, Cham. https://doi.org/10.1007/978-3-319-42792-8_26

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-42792-8_26

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-42790-4

  • Online ISBN: 978-3-319-42792-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation