Epidemiology, Classification, Etiopathogenesis, and Diagnosis of Acute Pancreatitis

  • Gianluca Guercioni
  • Walter Siquini
  • Emidio Senati
Part of the Updates in Surgery book series (UPDATESSURG)


In 1925, Moynihan described the dramatic nature of acute pancreatitis as the “most terrible of all calamities that occurs in connection with the abdominal viscera. The suddenness of its onset, the illimitable agony which accompanies it, and the mortality attendant upon it renders it the most formidable of catastrophes” [1]. From mild and self-limiting disease to multiorgan failure and sepsis, acute pancreatitis is a disorder that has numerous causes, an obscure pathogenesis, few effective remedies, and an often unpredictable outcome. The anatomopathological alterations of the pancreatic parenchyma vary from interstitial edema and very limited necrosis of the parenchymal fat to extensive areas of pancreatic necrosis and bleeding.


Acute Pancreatitis Acinar Cell Severe Acute Pancreatitis Pancreatic Necrosis Autoimmune Pancreatitis 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Moynihan B (1925) Acute pancreatitis. Ann Surg 81:132–142CrossRefPubMedGoogle Scholar
  2. 2.
    Cavallini G, Riela A, Brocco G et al (1987) Epidemiology of acute pancreatitis. In: Beger HG, Büchler M (eds) Acute pancreatitis: research and clinical management. Springer, Berlin Heidelberg New York, pp 25–31Google Scholar
  3. 3.
    Thomson SR, Hendry WS, McFarlane GA, Davidson AI (1987) Epidemiology and outcome of acute pancreatitis. Br J Surg 74:398–401CrossRefPubMedGoogle Scholar
  4. 4.
    Bourke JB (1975) Variation in annual incidence of primary acute pancreatitis in Nottingham, 1969-74. Lancet 2:967–969CrossRefPubMedGoogle Scholar
  5. 5.
    Wilson C, Imrie CW (1980) Changing patterns of incidence and mortality from acute pancreatitis in Scotland, 1961–1985. Br J Surg 77:731–734CrossRefGoogle Scholar
  6. 6.
    Russo MW, Wei JT, Thiny MT et al (2004) Digestive and liver diseases statistics, 2004. Gastroenterology 126:1448–1453CrossRefPubMedGoogle Scholar
  7. 7.
    DeFrances CJ, Hall MJ, Podgornik MN (2005) 2003 National Hospital Discharge Survey. Advance data from vital and health statistics. No. 359. Hyattsville, Md: National Center for Health StatisticsGoogle Scholar
  8. 8.
    Werner J, Uhl W, Büchler MW (2004) Acute pancreatitis. In: Cameron JL (ed) Current surgical therapy, 8th edn. Mosby, PhiladelphiaGoogle Scholar
  9. 9.
    Triester SL, Kowdley KV (2002) Prognostic factors in acute pancreatitis. J Clin Gastroenterol 34:167–176CrossRefPubMedGoogle Scholar
  10. 10.
    McKay CJ, Imrie CW (2004) The continuing challenge of early mortality in acute pancreatitis. Br J Surg 91:1243–1244CrossRefPubMedGoogle Scholar
  11. 11.
    Bradley EL (1993) A clinically based classification system for acute pancreatitis: summary of the Atlanta symposium. Arch Surg 128:586–590PubMedGoogle Scholar
  12. 12.
    Rigamonti M, Ferraro A, Madau A, Simonini L (2001) Stadiazione e monitoraggio della pancreatite acuta. In: D’Amico DF, Favia G, Eccher C (eds) Pancreatite acuta. Aspetti diagnostico-terapeutici. Atti del convegno Pancreatite acuta, Trento. La Garangola, PaduaGoogle Scholar
  13. 13.
    Opie EL (1901) The relation of cholelithiasis to disease of the pancreas and to fat necrosis. Am J Med Sci 121:27–43CrossRefGoogle Scholar
  14. 14.
    Yeo CJ, Cameron JL (2001) Exocrine pancreas. In: Townsend CM, Beauchamp RD, Evers BM, Maddox KL (eds) Sabiston textbook of surgery, 16th edn. Saunders, Philadelphia, pp 1112–1143Google Scholar
  15. 15.
    Favia G, Polistina F (2000) Pancreas. In: D’amico DF (ed) Manuale di Chirurgia. McGraw Hill, Milan, pp 674–675Google Scholar
  16. 16.
    Amman RW, Muelhaut B (1994) Progression of alcoholic acute to chronic pancreatitis. Gut 35:552–556CrossRefGoogle Scholar
  17. 17.
    Symmers WSC (1917) Acute alcoholic pancreatitis. Dublin J Med Sci 143:244–247Google Scholar
  18. 18.
    Hanck C, Whitcomb DC (2004) Alcoholic pancreatitis. Gastroenterol Clin North Am 33:751CrossRefPubMedGoogle Scholar
  19. 19.
    Yadav D, Pitchumoni CS (2005) Issues in hyperlipidemic pancreatitis. J Clin Gastroenterol 36:54CrossRefGoogle Scholar
  20. 20.
    Fortson MR, Freedman SN, Webster PD III (1995) Clinical assessment of hyperlipidemic pancreatitis. Am J Gastroenterol 90:2134–2139PubMedGoogle Scholar
  21. 21.
    Whitcomb DC, Gorry MC, Preston RA et al (1996) Hereditary pancreatitis is caused by a mutation in the cationic trypsinogen gene. Nat Genet 14:141–45CrossRefPubMedGoogle Scholar
  22. 22.
    Varallyay E, Pal G, Patthy A et al (1998) Two mutations in rat trypsin confer resistance against autolysis. Biochem Biophys Res Commun 243:56–60CrossRefPubMedGoogle Scholar
  23. 23.
    Whang EE (2006) Acute pancreatitis. In: Greenfield LJ, Mulholland MW, Oldham KT et al. (ed) Greenfield’s surgery: scientific principles and practice, 4th edn. Lippincott Williams and Wilkins, PhiladelphiaGoogle Scholar
  24. 24.
    Lora LP, Chari ST (2005) Autoimmune pancreatitis. Curr Gastroenterol Rep 7:101CrossRefGoogle Scholar
  25. 25.
    Klein SD, Affronti JP (2004) Pancreas divisum, an evidence-based review: part I, pathophysiology. Gastrointest Endosc 60:419CrossRefPubMedGoogle Scholar
  26. 26.
    Klein SD, Affronti JP (2004) Pancreas divisum, an evidence-based review: part II, patient selection and treatment. Gastrointest Endosc 60:585CrossRefPubMedGoogle Scholar
  27. 27.
    Trivedi CD, Pitchumoni CS (2005) Drug-induced pancreatitis: an update. J Clin Gastroenterol 239:709CrossRefGoogle Scholar
  28. 28.
    Wilson RH, Moorhead RJ (1991) Current management of trauma to the pancreas. Br J Surg 78:1196–1202CrossRefPubMedGoogle Scholar
  29. 29.
    Pezzulli R, Romboli E, Campana D, Corinaldesi R (2002) Mechanisms involved in the onset of post-ERCP pancreatitis. JOP. J Pancreas (Online) 3(6):162–168Google Scholar
  30. 30.
    Draganov P, Forsmark CE (2006) Gastroenterology V: Diseases of the pancreas. ACP Medicine online. WebMD Inc. [accessed 17 June 2008]Google Scholar
  31. 31.
    Reisler RB, Murphy RL, Redfield RR et al (2005) Incidence of pancreatitis in HIV-1 infected individuals enrolled in 20 adult AIDS clinical trials group studies: lessons learned. J Acquir Immune Defic Syndr 37:565Google Scholar
  32. 32.
    Khuroo MS, Zargar SA, Yattoo GN et al (1992) Ascaris-induced acute pancreatitis. Br J Surg 79:1335–1338CrossRefPubMedGoogle Scholar
  33. 33.
    Ros E, Navarro S, Bru C et al (1991) Occult microlithiasis in “idiopathic” acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology 101:1701PubMedGoogle Scholar
  34. 34.
    Lee Sp, Nichols JP, Park Hz (1992) Biliary sludges as a cause of acute pancreatitis. N Engl J Med 326:589PubMedGoogle Scholar
  35. 35.
    Halangk W, Lerch MM (2004) Early events in acute pancreatitis. Gastroenterol Clin North Am 33:717CrossRefPubMedGoogle Scholar
  36. 36.
    Bathia M, Wong Fl, Cao Y et al (2005) Pathophysiology of acute pancreatitis. Pancreatology 5:132CrossRefGoogle Scholar
  37. 37.
    van Acker G JD, Perides G, Steer ML (2006) Co-localization hypothesis: a mechanism for the intrapancreatic activation of digestive enzymes during the early phases of acute pancreatitis. World J Gastroenterol 12:1985–1990PubMedGoogle Scholar
  38. 38.
    Palade G (1975) Intracellular aspects of the process of protein synthesis. Science 189:347–358CrossRefPubMedGoogle Scholar
  39. 39.
    Kelly RB (1985) Pathways of protein secretion in eukaryotes. Science 230:25–32CrossRefPubMedGoogle Scholar
  40. 40.
    Karanjia ND, Widdison AL, Jehanli A et al (1993) Assay of trypsinogen activation in the cat experimental model of acute pancreatitis. Pancreas 8:189–195CrossRefPubMedGoogle Scholar
  41. 41.
    Kornfeld S (1986) Trafficking of lysosomal enzymes in normal and disease states. J Clin Invest 77:1–6CrossRefPubMedGoogle Scholar
  42. 42.
    Andrews NW (2000) Regulated secretion of conventional lysosomes. Trends Cell Biol 10:316–321CrossRefPubMedGoogle Scholar
  43. 43.
    Ishidoh K, Kominami E (2002) Processing and activation of lysosomal proteinases. Biol Chem 383:1827–1831CrossRefPubMedGoogle Scholar
  44. 44.
    Saluja A, Hashimoto S, Saluja M et al (1987) Subcellular redistribution of lysosomal enzymes during caerulein-induced pancreatitis. Am J Physiol 253:G508–G516PubMedGoogle Scholar
  45. 45.
    Hofbauer B, Saluja AK, Lerch MM et al (1998) Intra-acinar cell activation of trypsinogen during caerulein-induced pancreatitis in rats. Am J Physiol 275:G352–G362PubMedGoogle Scholar
  46. 46.
    Otani T, Chepilko SM, Grendell JH, Gorelick FS (1998) Codistribution of TAP and the granule membrane protein GRAMP-92 in rat caerulein-induced pancreatitis. Am J Physiol 275:G999–G1009PubMedGoogle Scholar
  47. 47.
    Greenbaum LM, Hirshkowitz A, Shoichet I (1959) The activation of trypsinogen by cathepsin B. J Biol Chem 234:2885–2890PubMedGoogle Scholar
  48. 48.
    Figarella C, Miszczuk-Jamska B, Barrett AJ (1988) Possible lysosomal activation of pancreatic zymogens. Activation of both human trypsinogens by cathepsin B and spontaneous acid. Activation of human trypsinogen 1. Biol Chem Hoppe Seyler 369(Suppl): 293–298PubMedGoogle Scholar
  49. 49.
    Watanabe O, Baccino FM, Steer ML, Meldolesi J (1984) Supramaximal caerulein stimulation and ultrastructure of rat pancreatic acinar cell: early morphological changes during development of experimental pancreatitis. Am J Physiol 246:G457–G467PubMedGoogle Scholar
  50. 50.
    Gennaro A, Stefanelli N, Vassiliadis A (2001) Quadro clinico e fisiopatologia della pancreatite acuta. In: D’Amico DF, Favia G, Eccher C (eds) Pancreatite acuta. Aspetti diagnosticoterapeutici. Atti del convegno Pancreatite acuta, Trento. La Garangola, MilanGoogle Scholar
  51. 51.
    Pederzoli P, Giardino A, Bandoni L et al (2005) Pancreatite acuta. In: Staudacher C (ed) Chirurgia d’urgenza. Masson, Milan, pp 115–131Google Scholar
  52. 52.
    Chvanov M, Petersen OH, Tepikin A (2005) Free radicals and the pancreatic acinar cells: role in physiology and pathology. Philos Trans R Soc Lond B Biol Sci 360:2273–2284CrossRefPubMedGoogle Scholar
  53. 53.
    Lipsett PA (2001) Serum cytokines, proteins, and receptors in acute pancreatitis: mediators, marker, or more of the same? Crit Care Med 29:1642–1644CrossRefPubMedGoogle Scholar
  54. 54.
    Hirota M, Nozawa F, Okabe A et al (2000) Relationship between plasma cytokine concentration and multiple organ failure in patients with acute pancreatitis. Pancreas 21:141–146CrossRefPubMedGoogle Scholar
  55. 55.
    Ogawa M (1998) Acute pancreatitis and cytokines: “second attack” by septic complication leads to organ failure. Pancreas 16:312–315CrossRefPubMedGoogle Scholar
  56. 56.
    Liu LR, Xia SH (2006) Role of platelet-activating factor in the pathogenesis of acute pancreatitis. World J Gastroenterol 12:539–545PubMedGoogle Scholar
  57. 57.
    Gukovskaya AS, Gukovsky I, Zaninovic V et al (1997) Pancreatic acinar cells produce, release, and respond to tumor necrosis factor-α. Role in regulating cell death and pancreatitis. J Clin Invest 100:1853–1862CrossRefPubMedGoogle Scholar
  58. 58.
    Denham W, Norman J (1999) The potential role of therapeutic cytokine manipulation in acute pancreatitis. Surg Clin North Am 79:767–781CrossRefPubMedGoogle Scholar
  59. 59.
    Pezzilli R, Billi P, Miniero R et al (1995) Serum interleukin-6, interleukin-8, and beta 2-microglobulin in early assessment of severity of acute pancreatitis. Comparison with serum C-reactive protein. Dig Dis Sci 40:2341–2348CrossRefPubMedGoogle Scholar
  60. 60.
    Gross V, Andreesen R, Leser HG et al (1992) Interleukin-8 and neutrophil activation in acute pancreatitis. Eur J Clin Invest 22:200–203CrossRefPubMedGoogle Scholar
  61. 61.
    Browne GW, Pitchumoni CS (2006) Pathophysiology of pulmonary complications of acute pancreatitis. World J Gastroenterol 12:7087–7096PubMedGoogle Scholar
  62. 62.
    Zhang XP, Tian H (2007) Pathogenesis of pancreatic encephalopathy in severe acute pancreatitis. Hepatobiliary Pancreat Dis Int 6:134–140PubMedGoogle Scholar
  63. 63.
    Zhang XP, Wang L, Zhang J (2007) Study progress on mechanism of severe acute pancreatitis complicated with hepatic injury. J Zhejiang Univ Sci B 8(4):228–236CrossRefPubMedGoogle Scholar
  64. 64.
    Schmid SW, Uhl W, Friess H et al (1999) The role of infection in acute pancreatitis. Gut 45:311–316CrossRefPubMedGoogle Scholar
  65. 65.
    Clavien PA, Burgan S, Moossa AR (1989) Serum enzymes and other laboratory tests in acute pancreatitis. Br J Surg 76:1234–1243CrossRefPubMedGoogle Scholar
  66. 66.
    Al-Bahrani AZ, Ammori BJ (2005) Clinical laboratory assessment of acute pancreatitis. Clin Chim Acta 362:26CrossRefPubMedGoogle Scholar
  67. 67.
    Smotkin J, Tenner S (2002) Clinical reviews: pancreatic and biliary disease: laboratory diagnostic tests in acute pancreatitis. J Clin Gastroenterol 34:459–462CrossRefPubMedGoogle Scholar
  68. 68.
    Yadav D, Agarwal N, Pitchumoni CS (2002) A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol 97:1309–1318CrossRefPubMedGoogle Scholar
  69. 69.
    Clavien PA, Robert J, Meyer P et al (1989) Acute pancreatitis and normoamylasemia. Not an uncommon combination. Ann Surg 210:614–620CrossRefPubMedGoogle Scholar
  70. 70.
    Winslet M, Hall C, London NJ, Neoptolemos JP (1992) Relation of diagnostic serum amylase levels to aetiology and severity of acute pancreatitis. Gut 33:982–986CrossRefPubMedGoogle Scholar
  71. 71.
    Matull WR, Pereira SP, O’Donohue JW (2006) Biochemical markers of acute pancreatitis. J Clin Pathol 59:340–344CrossRefPubMedGoogle Scholar
  72. 72.
    American Gastroenterological Association (AGA) Institute on “Management of Acute Pancreatitis” Clinical Practice and Economics Committee; AGA Institute Governing Board. (2007) AGA Institute medical position statement on acute pancreatitis. Gastroenterology 132:2019–2021Google Scholar
  73. 73.
    Banks PA, Freeman ML (2006) Practice Parameters Committee of the American College of Gastroenterology. Practice guidelines in acute pancreatitis. Am J Gastroenterol 101:2379–2400CrossRefPubMedGoogle Scholar
  74. 74.
    Schein M (2005) Acute pancreatitis. In: Shein M, Rogers PM (eds) Schein’s common sense emergency abdominal surgery. Springer, pp 151–161Google Scholar
  75. 75.
    Baron TH, Morgan D (1999) Acute necrotizing pancreatitis. N Engl J Med 340:1412–1416CrossRefPubMedGoogle Scholar
  76. 76.
    Ranson JH, Rifkind KM, Roses DF et al (1974) Prognostic signs and the role of operative management in acute pancreatitis. Surg Gynecol Obstet 139:69–81PubMedGoogle Scholar
  77. 77.
    Ranson JH (1982) Etiological and prognostic factors in human acute pancreatitis: a review. Am J Gastroenterol 77:633–638PubMedGoogle Scholar
  78. 78.
    Imrie CW, Benjamin IS, Ferguson JC et al (1978) A single-center double-blind trial of Trasylol therapy in primary acute pancreatitis. Br J Surg 65:337–341CrossRefPubMedGoogle Scholar
  79. 79.
    Larvin M, McMahon MJ (1989) APACHE-II score for assessment and monitoring of acute pancreatitis. Lancet 2:201–205CrossRefPubMedGoogle Scholar
  80. 80.
    Osvaldt AB, Viero P, Borges da Costa MS et al (2002) l. Evaluation of Ranson, Glasgow, APACHE II and APACHE 0 criteria to predict severity in acute pancreatitis. Int Surg 86(3):158–161Google Scholar
  81. 81.
    Gürleyik G, Emir S, Kiliçoglu G et al(2005) Computed Tomography Severity Index, APACHE II score and serum CRP concentration for predicting the severity of acute pancreatitis. JOP J Pancreas 6:562–567Google Scholar
  82. 82.
    Sandberg AA, Borgström A (2002) Early prediction of severity in acute pancreatitis. Is this possible? JOP J Pancreas (Online) 3(5):116–125Google Scholar
  83. 83.
    Wilson C, Heads A, Shenkin A, Imrie CW (1989) C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis. Br J Surg 76:177–181CrossRefPubMedGoogle Scholar
  84. 84.
    Neoptolemos JP, Kemppainen EA, Mayer JM et al (2000) Early prediction of severity in acute pancreatitis by urinary trypsinogen activation peptide: a multicentre study. Lancet 355:1955–1960CrossRefPubMedGoogle Scholar
  85. 85.
    Puolakkainen P, Valtonen V, Paananen A, Schröder T (1987) C-reactive protein (CRP) and serum phospholipase A2 in the assessment of acute pancreatitis. Gut 28:764–771CrossRefPubMedGoogle Scholar
  86. 86.
    Assicot M, Gendrel D, Carsin H et al (1993) Serum pro-calcitonin and C-reactive protein levels as markers of bacterial infection. Lancet 341:515–518CrossRefPubMedGoogle Scholar
  87. 87.
    Rau B, Steinbach G, Gansauge F et al (1997) The potential role of procalcitonin and interleukin 8 in the prediction of infected necrosis in acute pancreatitis. Gut 41:832–840PubMedCrossRefGoogle Scholar
  88. 88.
    Rau BM, Kemppainen EA, Gumbs AA et al (2007) Early assessment of pancreatic infections and overall prognosis in severe acute pancreatitis by procalcitonin (PCT). A prospective international multicenter study. Ann Surg 245:745–754CrossRefPubMedGoogle Scholar
  89. 89.
    Frossard JL, Hadengue A, Pastor CM (2001) New serum markers for the detection of severe acute pancreatitis in humans. Am J Respir Crit Care Med 164:162–170PubMedGoogle Scholar

Copyright information

© Springer-Verlag Italia 2009

Authors and Affiliations

  • Gianluca Guercioni
    • 1
  • Walter Siquini
    • 2
  • Emidio Senati
    • 1
  1. 1.Division of General SurgeryC. e G. Mazzoni County HospitalAscoli PicenoItaly
  2. 2.Department of Surgery, Ospedali Riuniti University HospitalPolytechnic University of MarcheAnconaItaly

Personalised recommendations