In acute pancreatitis the pancreas becomes suddenly inflamed, most often because of gallstones or heavy alcohol use, and its own enzymes injure the gland. Most cases settle with fluids and support, but a severe attack can cause organ failure.
Key symptoms
- Sudden, steady pain in the upper belly that often goes through to the back
- Nausea and repeated vomiting
- Pain worse after eating and eased by leaning forward
- Fever and a fast heartbeat in more severe attacks
What you find on exam
- Tenderness and guarding in the upper abdomen
- Fast pulse, low blood pressure or fever; check fluid status
- Yellow eyes or skin if a gallstone blocks the bile duct
- Bruising around the navel or flanks in rare severe bleeding cases
Tests
- Serum lipase at least three times the upper limit of normal
- Liver tests, triglycerides, calcium, kidney function and blood count
- Right upper quadrant ultrasound to look for gallstones
- CT scan only if the diagnosis is unclear or the patient is not improving
Treatment basics
- Early IV fluids with lactated Ringer's, guided by urine output and vital signs
- Pain control, often with an opioid such as hydromorphone, and antiemetics
- Start eating early as soon as tolerated
- Treat the cause: ERCP for blocked bile duct with cholangitis, gallbladder removal before discharge for gallstones, stop alcohol
Red flags
- Low blood pressure, low oxygen or falling urine output
- Confusion or worsening breathing
- Fever with jaundice suggesting infection of the bile duct
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.