Potentially life-threatening emergency
Acute pancreatitis
Alerts and Notices
Synopsis
An acute inflammatory process of the pancreas characterized by sudden onset of severe epigastric pain which radiates most commonly to the back, associated with nausea and vomiting. Most common causes in the United States are from gallstones and chronic alcohol consumption. Prevalence is highest among daily alcohol drinkers and patients with a high predisposition for gallstone formation: risk factors include female sex, advanced age (fourth decade of life and beyond), high serum triglycerides, obesity, and pregnancy. Many medications can also predispose to gallstone formation, increasing the risk of pancreatitis. Certain genetic mutations (eg, cystic fibrosis) and autoimmune diseases can also cause pancreatitis, although these make up a small subset of the overall cases of pancreatitis.Physical examination typically reveals a patient in distress with tachycardia, tachypnea, fever, and midline epigastric abdominal tenderness or rigidity. Rare findings include a faint blue discoloration around the umbilicus (Cullen sign) or blue-purple / green-brown discoloration of the flanks (Turner sign) in patients with necrotizing pancreatitis. Other associated signs and symptoms are specific to the etiology of pancreatitis.
Patients with gallstone pancreatitis may have concurrent choledocholithiasis or biliary colic, and their history may reveal right upper quadrant abdominal pain and jaundice in addition to epigastric pain radiating to the back.
Pancreatitis secondary to hypertriglyceridemia typically presents in patients with a triglyceride level >1000, which is often hereditary and not dietary in etiology. Medical therapy for triglyceride lowering is recommended for patients with triglyceride levels >500. Although increased rates of pancreatitis are associated with elevated triglycerides <500, whether this relationship is causal or an incidental association requires more research. For patients with elevated triglycerides but levels <500, lifestyle changes are recommended.
Many medications have been associated with pancreatitis as a side effect. Common medications include 6-mercaptopurine, aminosalicylates, sulfonamides, diuretics (eg, hydrochlorothiazide), valproic acid, pentamidine, tetracycline, and estrogen.
Acute pancreatitis can range in severity from mild to severe. Mild cases are often self-limited to 1-2 days and improve with intravenous fluids and initial bowel rest, but oral nutrition can often be restarted within 24-48 hours. Severe pancreatitis can lead to acute respiratory distress syndrome, multiorgan failure, pancreas necrosis, and secondary infections, requiring antibiotics, bowel rest, and, in some cases, mechanical intubation and vasopressor support. Overall mortality from acute pancreatitis is 2%.
Related topics: Chronic pancreatitis, Pancreatic panniculitis
Codes
ICD10CM:K85.90 – Acute pancreatitis without necrosis or infection, unspecified
SNOMEDCT:
197456007 – Acute Pancreatitis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Acute cholecystitis
- Acute appendicitis
- Chronic pancreatitis
- Biliary colic / cholelithiasis
- Coronary artery disease
- Myocardial infarction
- Esophageal spasm
- Zollinger-Ellison syndrome
- Acute hepatitis
- Choledocholithiasis
- Viral gastroenteritis
- Pyelonephritis
- Ischemic colitis
- Diverticulitis
- Inflammatory bowel disease (eg, Crohn disease, ulcerative colitis)
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.Subscription Required
References
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Last Reviewed:12/14/2016
Last Updated:09/16/2020
Last Updated:09/16/2020
Potentially life-threatening emergency
Acute pancreatitis