Pancreatitis

The most common symptoms of pancreatitis are severe upper abdominal or left upper quadrant burning pain radiating to the back, nausea, and vomiting that is worse with eating. The physical examination will vary depending on severity and presence of internal bleeding. Blood pressure may be elevated by pain or decreased by dehydration or bleeding. Heart and respiratory rates are often elevated. The abdomen is usually tender but to a lesser degree than the pain itself. As is common in abdominal disease, bowel sounds may be reduced from reflex bowel paralysis. Fever or jaundice may be present. Chronic pancreatitis can lead to diabetes or pancreatic cancer. Unexplained weight loss may occur from a lack of pancreatic enzymes hindering digestion.{{citation needed|date=July 2022}}

Early complications include shock, infection, systemic inflammatory response syndrome, low blood calcium, high blood glucose, and dehydration. Blood loss, dehydration, and fluid leaking into the abdominal cavity (ascites) can lead to kidney failure. Respiratory complications are often severe. Pleural effusion is usually present. Shallow breathing from pain can lead to lung collapse. Pancreatic enzymes may attack the lungs, causing inflammation. Severe inflammation can lead to intra-abdominal hypertension and abdominal compartment syndrome, further impairing renal and respiratory function and potentially requiring management with an open abdomen to relieve the pressure.{{cite journal | vauthors = Fitzgerald JE, Gupta S, Masterson S, Sigurdsson HH | title = Laparostomy management using the ABThera™ open abdomen negative pressure therapy system in a grade IV open abdomen secondary to acute pancreatitis | journal = International Wound Journal | volume = 10 | issue = 2 | pages = 138–144 | date = April 2013 | pmid = 22487377 | pmc = 7950789 | doi = 10.1111/j.1742-481X.2012.00953.x | s2cid = 2459785 }}

Late complications include recurrent pancreatitis and the development of pancreatic pseudocysts—collections of pancreatic secretions that have been walled off by scar tissue. These may cause pain, become infected, rupture and bleed, block the bile duct and cause jaundice, or migrate around the abdomen. Acute necrotizing pancreatitis can lead to a pancreatic abscess, a collection of pus caused by necrosis, liquefaction, and infection. This happens in approximately 3% of cases or almost 60% of cases involving more than two pseudocysts and gas in the pancreas.{{EMedicine|article|181264|Pancreatic abscess}}

About 80 percent of pancreatitis cases are caused by gallstones or alcohol. Choledocholithiasis (gallstones in the bile duct) are the single most common cause of acute pancreatitis,{{cite web |author=NIDDK |title=Pancreatitis |date=July 2008 |work=National Digestive Diseases Information Clearinghouse |publisher=U.S. National Institute of Diabetes and Digestive and Kidney Diseases |url=http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/ |id=08–1596 |archive-url=https://web.archive.org/web/20070107120906/http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/ |archive-date=2007-01-07 |access-date=2007-01-05 }} and alcoholism is the single most common cause of chronic pancreatitis.{{cite web |url=http://www.umm.edu/altmed/articles/pancreatitis-000122.htm |title=Pancreatitis |publisher=A.D.A.M., Inc. |access-date=2013-01-05 |url-status=live |archive-url=https://web.archive.org/web/20121230085927/http://www.umm.edu/altmed/articles/pancreatitis-000122.htm |archive-date=2012-12-30 }}{{cite journal | vauthors = Apte MV, Pirola RC, Wilson JS | title = Pancreas: alcoholic pancreatitis--it's the alcohol, stupid | journal = Nature Reviews. Gastroenterology & Hepatology | volume = 6 | issue = 6 | pages = 321–322 | date = June 2009 | pmid = 19494819 | doi = 10.1038/nrgastro.2009.84 | s2cid = 6580794 }}

• {{lay source |template=cite web |vauthors=Apte MV, Pirola RC, Wilson JS |title=Pancreas: Alcoholic Pancreatitis—It's the Alcohol, Stupid |website=Medscape Today |url=http://www.medscape.com/viewarticle/706319 |url-access=registration}}{{cite journal | vauthors = Yadav D, Hawes RH, Brand RE, Anderson MA, Money ME, Banks PA, Bishop MD, Baillie J, Sherman S, DiSario J, Burton FR, Gardner TB, Amann ST, Gelrud A, Lawrence C, Elinoff B, Greer JB, O'Connell M, Barmada MM, Slivka A, Whitcomb DC | title = Alcohol consumption, cigarette smoking, and the risk of recurrent acute and chronic pancreatitis | journal = Archives of Internal Medicine | volume = 169 | issue = 11 | pages = 1035–1045 | date = June 2009 | pmid = 19506173 | pmc = 6785300 | doi = 10.1001/archinternmed.2009.125 }}{{cite web |title=Pancreatitis Explained |year=2011 |work=Better Health Channel |publisher=State Government of Victoria |url=http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/pancreatitis_explained?opendocument |archive-url=https://web.archive.org/web/20100513082527/http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Pancreatitis_explained?OpenDocument |archive-date=2010-05-13 }}{{cite journal | vauthors = Johnson CD, Hosking S | title = National statistics for diet, alcohol consumption, and chronic pancreatitis in England and Wales, 1960-88 | journal = Gut | volume = 32 | issue = 11 | pages = 1401–1405 | date = November 1991 | pmid = 1752477 | pmc = 1379177 | doi = 10.1136/gut.32.11.1401 }} Serum triglyceride levels greater than 1000 mg/dL (11.29 mmol/L, i.e. hyperlipidemia) is another cause.{{cite journal | vauthors = Rawla P, Sunkara T, Thandra KC, Gaduputi V | title = Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies | journal = Clinical Journal of Gastroenterology | volume = 11 | issue = 6 | pages = 441–448 | date = December 2018 | pmid = 29923163 | doi = 10.1007/s12328-018-0881-1 | s2cid = 49311482 }}

The mnemonic "GET SMASHED" is often used to help clinicians and medical students remember the common causes of pancreatitis: Gallstones, Ethanol, Trauma, Steroids, Mumps, Autoimmune, Scorpion sting, Hyperlipidemia, hypothermia or hyperparathyroidism, ERCP, Drugs (commonly azathioprine, valproic acid, liraglutide).{{cite web |url= https://radiopaedia.org/articles/causes-of-pancreatitis-mnemonic | title= Causes of pancreatitis (mnemonic)

| website= Radiopaedia.org |access-date= 26 June 2021}}

There are seven classes of medications associated with acute pancreatitis: statins, ACE inhibitors, oral contraceptives/hormone replacement therapy (HRT), diuretics, antiretroviral therapy, valproic acid, and oral hypoglycemic agents. Mechanisms of these drugs causing pancreatitis are not known exactly, but it is possible that statins have direct toxic effect on the pancreas or through the long-term accumulation of toxic metabolites. Meanwhile, ACE inhibitors cause angioedema of the pancreas through the accumulation of bradykinin. Birth control pills and HRT cause arterial thrombosis of the pancreas through the accumulation of fat (hypertriglyceridemia). Diuretics such as furosemide have a direct toxic effect on the pancreas. Meanwhile, thiazide diuretics cause hypertriglyceridemia and hypercalcemia, where the latter is the risk factor for pancreatic stones.{{citation needed|date=July 2022}}

HIV infection itself can cause a person to be more likely to get pancreatitis. Meanwhile, antiretroviral drugs may cause metabolic disturbances such as hyperglycemia and hypercholesterolemia, which predisposes to pancreatitis. Valproic acid may have direct toxic effect on the pancreas.{{cite journal | vauthors = Kaurich T | title = Drug-induced acute pancreatitis | journal = Proceedings | volume = 21 | issue = 1 | pages = 77–81 | date = January 2008 | pmid = 18209761 | pmc = 2190558 | doi = 10.1080/08998280.2008.11928366 }} Various oral hypoglycemic agents are associated with pancreatitis including metformin, but glucagon-like peptide-1 mimetics such as exenatide are more strongly associated with pancreatitis by promoting inflammation in combination with a high-fat diet.{{cite journal | vauthors = Jones MR, Hall OM, Kaye AM, Kaye AD | title = Drug-induced acute pancreatitis: a review | journal = Ochsner Journal | volume = 15 | issue = 1 | pages = 45–51 | date = 2015 | pmid = 25829880 | pmc = 4365846 | quote = "Various oral hypoglycemic agents used in the treatment of diabetes are linked to acute pancreatitis. While some association exists between the occurrence of pancreatitis and biguanide agents such as metformin, as well as with dipeptidyl peptidase 4 inhibitors, including sitagliptin, vildagliptin, and saxagliptin, current research suggests that the only oral hypoglycemic agents with a disproportionately increased risk of pancreatitis are the glucagon-like peptide-1 (GLP-1) mimetics. Of particular concern is exenatide that was linked to 36 postmarketing reports of acute pancreatitis soon after its introduction. Further inquiry has estimated a 6-fold increase in the risk of pancreatitis with the use of exenatide compared to other therapies. The pathogenesis of GLP-1 analog-induced pancreatitis is unclear, but current evidence suggests an additive or synergistic exacerbation of pancreatitis when GLP-1 analogs are used in the presence of a high fat diet. The sequence of injury appears to begin with acinar cell hypertrophy, progress to proinflammatory cytokine induction, and culminate in pancreatic vascular injury" }}

Atypical antipsychotics such as clozapine, risperidone, and olanzapine can also cause pancreatitis.{{cite journal | vauthors = Koller EA, Cross JT, Doraiswamy PM, Malozowski SN | title = Pancreatitis associated with atypical antipsychotics: from the Food and Drug Administration's MedWatch surveillance system and published reports | journal = Pharmacotherapy | volume = 23 | issue = 9 | pages = 1123–1130 | date = September 2003 | pmid = 14524644 | doi = 10.1592/phco.23.10.1123.32759 | url = http://www.medscape.com/viewarticle/461398_3 | url-status = live | s2cid = 39945446 | archive-url = https://web.archive.org/web/20110208222922/http://www.medscape.com/viewarticle/461398_3 | archive-date = 2011-02-08 | url-access = subscription }}

A number of infectious agents have been recognized as causes of pancreatitis including:{{cite journal | vauthors = Rawla P, Bandaru SS, Vellipuram AR | title = Review of Infectious Etiology of Acute Pancreatitis | journal = Gastroenterology Research | volume = 10 | issue = 3 | pages = 153–158 | date = June 2017 | pmid = 28725301 | pmc = 5505279 | doi = 10.14740/gr858w }}{{cite journal | vauthors = Parenti DM, Steinberg W, Kang P | title = Infectious causes of acute pancreatitis | journal = Pancreas | volume = 13 | issue = 4 | pages = 356–371 | date = November 1996 | pmid = 8899796 | doi = 10.1097/00006676-199611000-00005 }}{{cite journal| vauthors = Economou M, Zissis M |title=Infectious cases of acute pancreatitis|journal=Annals of Gastroenterology|date=2000|volume=13|issue=2|pages=98–101|url=http://www.annalsgastro.gr/files/journals/1/articlessos/4/submission/editor/4-16-1-ED.pdf|access-date=22 November 2017|archive-url=https://web.archive.org/web/20170809111554/http://www.annalsgastro.gr/files/journals/1/articlessos/4/submission/editor/4-16-1-ED.pdf|archive-date=2017-08-09}}

• Viruses
• Coxsackie virus
• Cytomegalovirus
• Hepatitis B
• Herpes simplex virus
• Mumps
• Varicella-zoster virus
• Bacteria
• Legionella
• Leptospira
• Mycoplasma
• Salmonella
• Fungi
• Aspergillus
• Parasites
• Ascaris
• Cryptosporidium
• Toxoplasma

Other common causes include trauma, autoimmune disease, high blood calcium, hypothermia, and endoscopic retrograde cholangiopancreatography (ERCP). Pancreas divisum is a common congenital malformation of the pancreas that may underlie some recurrent cases. Diabetes mellitus type 2 is associated with a 2.8-fold higher risk.{{cite journal | vauthors = Noel RA, Braun DK, Patterson RE, Bloomgren GL | title = Increased risk of acute pancreatitis and biliary disease observed in patients with type 2 diabetes: a retrospective cohort study | journal = Diabetes Care | volume = 32 | issue = 5 | pages = 834–838 | date = May 2009 | pmid = 19208917 | pmc = 2671118 | doi = 10.2337/dc08-1755 | url = http://care.diabetesjournals.org/content/32/5/834.full | url-status = live | archive-url = https://web.archive.org/web/20120610163642/http://care.diabetesjournals.org/content/32/5/834.full | archive-date = 2012-06-10 }}

Less common causes include pancreatic cancer, pancreatic duct stones,{{cite journal | vauthors = Macaluso JN |title=Editorial Comment |journal=J. Urol. |volume=158 |issue=2 |page=522 |date=August 1997 | doi = 10.1016/S0022-5347(01)64525-7|url=http://www.jurology.com/article/S0022-5347%2801%2964525-7/fulltext|url-access=subscription }} on {{cite journal | vauthors = Matthews K, Correa RJ, Gibbons RP, Weissman RM, Kozarek RA | title = Extracorporeal shock wave lithotripsy for obstructing pancreatic duct calculi | journal = The Journal of Urology | volume = 158 | issue = 2 | pages = 522–525 | date = August 1997 | pmid = 9224338 | doi = 10.1016/s0022-5347(01)64524-5 }} vasculitis (inflammation of the small blood vessels in the pancreas), and porphyria—particularly acute intermittent porphyria and erythropoietic protoporphyria.{{citation needed|date=July 2022}}

There is an inherited form that results in the activation of trypsinogen within the pancreas, leading to autodigestion. Involved genes may include trypsin 1, which codes for trypsinogen, SPINK1, which codes for a trypsin inhibitor, or cystic fibrosis transmembrane conductance regulator.{{cite web| vauthors = Whitcomb D | year=2006| title=Genetic Testing for Pancreatitis| url=http://www.touchalimentarydisease.com/articles.cfm?article_id=6374&level=2| archive-url=https://web.archive.org/web/20171016070051/http://www.touchalimentarydisease.com/articles.cfm?article_id=6374&level=2| archive-date=2017-10-16}}

File:Pankreatitis exsudativ CT axial.jpg File:CalcifiedPanDucStoneandSomefluid.png

The differential diagnosis for pancreatitis includes but is not limited to cholecystitis, choledocholithiasis, perforated peptic ulcer, bowel infarction, small bowel obstruction, hepatitis, and mesenteric ischemia.{{Cite web|title = Clinical manifestations and diagnosis of acute pancreatitis|url = http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-acute-pancreatitis|website = www.uptodate.com|access-date = 2015-12-08|url-status = live|archive-url = https://web.archive.org/web/20151208191308/http://www.uptodate.com/contents/clinical-manifestations-and-diagnosis-of-acute-pancreatitis|archive-date = 2015-12-08}}

Diagnosis requires 2 of the 3 following criteria:{{citation needed|date=September 2024}}

• Characteristic acute onset of epigastric or vague abdominal pain that may radiate to the back (see signs and symptoms above)
• Serum amylase or lipase levels ≥ 3 times the upper limit of normal
• An imaging study with characteristic changes. CT, MRI, abdominal ultrasound or endoscopic ultrasound can be used for diagnosis.

Amylase and lipase are 2 enzymes produced by the pancreas. Elevations in lipase are generally considered a better indicator for pancreatitis as it has greater specificity and has a longer half life. However, both enzymes can be elevated in other disease states. In chronic pancreatitis, the fecal pancreatic elastase-1 (FPE-1) test is a marker of exocrine pancreatic function. Additional tests that may be useful in evaluating chronic pancreatitis include hemoglobin A1C, immunoglobulin G4, rheumatoid factor, and anti-nuclear antibody.{{cite book | veditors = Greenberger NJ, Wu B, Conwell D, Banks P | chapter=Chronic Pancreatitis | title=Gastroenterology, Hepatology, & Endoscopy | series=Current Medical Diagnosis and Treatment | page=301}}

For imaging, abdominal ultrasound is convenient, simple, non-invasive, and inexpensive.{{Cite book | vauthors = Tierney LW, McPhee SJ |title=Medicine |publisher=McGraw-Hill |isbn=978-0071444415 |date=2005-02-16 |url-access=registration |url=https://archive.org/details/harrisonsmanualo0000unse }} It is more sensitive and specific for pancreatitis from gallstones than other imaging modalities.{{Cite book|title = Hospitalist Handbook|edition = 4th|publisher = Department of Medicine University of California, San Francisco|year = 2012|pages = 224–25}} However, in 25–35% of patients the view of the pancreas can be obstructed by bowel gas making it difficult to evaluate.

A contrast-enhanced CT scan is usually performed more than 48 hours after the onset of pain to evaluate for pancreatic necrosis and extrapancreatic fluid as well as predict the severity of the disease. CT scanning earlier can be falsely reassuring.{{cite journal | vauthors = Türkvatan A, Erden A, Türkoğlu MA, Seçil M, Yener Ö | title = Imaging of acute pancreatitis and its complications. Part 1: acute pancreatitis | journal = Diagnostic and Interventional Imaging | volume = 96 | issue = 2 | pages = 151–160 | date = February 2015 | pmid = 24512896 | doi = 10.1016/j.diii.2013.12.017 | doi-access = free }}

ERCP or an endoscopic ultrasound can also be used if a biliary cause for pancreatitis is suspected.{{citation needed|date=July 2022}}

The treatment for acute pancreatitis will depend on whether the diagnosis is for the mild form of the condition, which typically resolves without treatment, or the severe form, which can cause serious complications. Patients with mild AP should still be hospitalized, at least briefly, to receive IV fluids and for clinical monitoring purposes.

Acute pancreatitis typically presents with severe to extreme abdominal pain.{{cite journal | vauthors = Szatmary P, Grammatikopoulos T, Cai W, Huang W, Mukherjee R, Halloran C, Beyer G, Sutton R | title = Acute Pancreatitis: Diagnosis and Treatment | journal = Drugs | volume = 82 | issue = 12 | pages = 1251–1276 | date = August 2022 | pmid = 36074322 | pmc = 9454414 | doi = 10.1007/s40265-022-01766-4 }} While the mildest cases of pancreatitis may be managed exclusively with NSAIDs (which are preferred in such scenarios due to the anti-inflammatory effects and the better safety profile), most patients with pancreatitis require heavy opioid regimens for pain therapy. Severe cases often require continuous IV infusions of opioid medications. It is appropriate for emergent cases of pancreatitis to be treated with these medications immediately, rather than attempting to control the pain with lesser medications first.

The early use of strong pain management therapies does not affect the ability for the physician to diagnose the cause of severe abdominal pain. Thus, pain management should not be reduced or withheld for the purposes of diagnosis in cases of suspected pancreatitis.{{cite journal | vauthors = Manterola C, Vial M, Moraga J, Astudillo P | title = Analgesia in patients with acute abdominal pain | journal = The Cochrane Database of Systematic Reviews | issue = 1 | pages = CD005660 | date = January 2011 | pmid = 21249672 | doi = 10.1002/14651858.CD005660.pub3 | collaboration = Cochrane Colorectal Cancer Group }}

Regardless of disease severity, moderately aggressive fluid resuscitation is advisable for all patients with acute pancreatitis, especially if they can be diagnosed and treated early in the course of the disease. The preferred fluid for administration is lactated Ringer solution, but saline may also be used. Patients with acute pancreatitis of any severity are typically hypovolemic (decreased blood volume), and this hypovolemia can result in hypoperfusion of pancreatic cells. Without blood supplying them, the pancreatic cells can become necrotic, resulting in tissue death that can become further worsened by the strong inflammatory response that occurs following necrosis.

Infection is a major cause of mortality in patients with pancreatitis, and these patients are known to be prone to infections in a variety of organ systems. The majority of patients with pancreatitis have damage to the gut barrier, allowing gut bacteria to bypass this barrier and cause infection. Some species of gut bacteria are also known to detect pancreatitis and respond by releasing their own pro-inflammatory molecules. Conversely, a healthy microbiome is beneficial for preventing infection, and several gut bacteria are known to augment human immune defenses and reduce systemic inflammation.{{cite journal | vauthors = Zhang C, Li G, Lu T, Liu L, Sui Y, Bai R, Li L, Sun B | title = The Interaction of Microbiome and Pancreas in Acute Pancreatitis | journal = Biomolecules | volume = 14 | issue = 1 | pages = 59 | date = December 2023 | pmid = 38254659 | pmc = 10813032 | doi = 10.3390/biom14010059 | doi-access = free }}

The treatment of mild acute pancreatitis is successfully carried out by admission to a general hospital ward for fluid resuscitation and patient monitoring. Traditionally, people were not allowed to eat until the inflammation resolved but more recent evidence suggests early feeding is safe and improves outcomes and may result in an ability to leave the hospital sooner, and guidelines have been updated to recommend early feeding for patients able to tolerate it.{{cite journal | vauthors = Vaughn VM, Shuster D, Rogers MA, Mann J, Conte ML, Saint S, Chopra V | title = Early Versus Delayed Feeding in Patients With Acute Pancreatitis: A Systematic Review | journal = Annals of Internal Medicine | volume = 166 | issue = 12 | pages = 883–892 | date = June 2017 | pmid = 28505667 | doi = 10.7326/M16-2533 | s2cid = 2025443 }}

Opioids may be used for the pain. When the pancreatitis is due to gallstones, or even for patients without gallstones and no other identifiable cause, early gallbladder removal also appears to improve outcomes.{{cite journal | vauthors = Moody N, Adiamah A, Yanni F, Gomez D | title = Meta-analysis of randomized clinical trials of early versus delayed cholecystectomy for mild gallstone pancreatitis | journal = The British Journal of Surgery | volume = 106 | issue = 11 | pages = 1442–1451 | date = October 2019 | pmid = 31268184 | doi = 10.1002/bjs.11221 | s2cid = 195787962 }}

Severe pancreatitis can cause organ failure, necrosis, infected necrosis, pseudocyst, and abscess. If diagnosed with severe acute pancreatitis, people will need to be admitted to a high-dependency unit or intensive care unit. It is likely that the levels of fluids inside the body will have dropped significantly as it diverts bodily fluids and nutrients in an attempt to repair the pancreas. The drop in fluid levels can lead to a rapid and severe reduction in the volume of blood within the body, which is known as hypovolemic shock. This condition represents a major life threat and may be prevented in some cases by prompt and aggressive fluid resuscitation.

Patients with severe AP are often unable to receive oral nutrition, and so nasogastric feeding tubes are commonly used for these patients. Feeding tubes may be used to provide calories and nutrients, combined with appropriate analgesia. Early enteral feeding within 48 hours of admission to the hospital has been associated with better outcomes.{{cite journal | vauthors = Li JY, Yu T, Chen GC, Yuan YH, Zhong W, Zhao LN, Chen QK | title = Enteral nutrition within 48 hours of admission improves clinical outcomes of acute pancreatitis by reducing complications: a meta-analysis | journal = PLOS ONE | volume = 8 | issue = 6 | pages = e64926 | date = Jun 6, 2013 | pmid = 23762266 | pmc = 3675100 | doi = 10.1371/journal.pone.0064926 | bibcode = 2013PLoSO...864926L | doi-access = free }}

The lungs can be inflamed as a result of the systemic inflammatory response and can manifest as acute respiratory distress syndrome (ARDS). Supplemental oxygen is frequently required in the treatment of severe AP, and a patient may be given anything from supplemental oxygen via nasal cannula, to full mechanical ventilation. In many cases, even the most intensive respiratory therapies are not enough, and many patients with severe pancreatitis die as a result of respiratory failure.{{cite journal | vauthors = Leppäniemi A, Tolonen M, Tarasconi A, Segovia-Lohse H, Gamberini E, Kirkpatrick AW, Ball CG, Parry N, Sartelli M, Wolbrink D, van Goor H, Baiocchi G, Ansaloni L, Biffl W, Coccolini F, Di Saverio S, Kluger Y, Moore E, Catena F | title = 2019 WSES guidelines for the management of severe acute pancreatitis | journal = World Journal of Emergency Surgery | volume = 14 | issue = 1 | pages = 27 | date = December 2019 | pmid = 31210778 | pmc = 6567462 | doi = 10.1186/s13017-019-0247-0 | doi-access = free }}{{Cite journal | vauthors = Thunaibat A, Omeish H, Rashid M |date=October 2023 |title=S2157 Necrotizing Pancreatitis Complicated by ARDS and GI Bleeding: A Case Report |url=https://journals.lww.com/ajg/fulltext/2023/10001/s2157_necrotizing_pancreatitis_complicated_by_ards.3034.aspx |journal=American Journal of Gastroenterology |language=en |volume=118 |issue=10S |pages=S1555–S1556 |doi=10.14309/01.ajg.0000958268.44340.46 |issn=0002-9270}}

As with mild pancreatitis, it will be necessary to treat the underlying cause—gallstones, discontinuing medications, cessation of alcohol, etc. If the cause is gallstones, it is likely that an ERCP procedure or removal of the gallbladder will be recommended. There is also evidence that, even for patients without gallstones, surgical removal of the gallbladder may reduce the risk of recurrence, and as of 2024, guidelines recommend the procedure for any patient with severe pancreatitis with no clear cause.

If the cause of pancreatitis is alcohol, cessation of alcohol consumption and treatment for alcohol dependency may improve pancreatitis. Even if the underlying cause is not related to alcohol consumption, many doctors recommend avoiding it for at least six months as this can cause further damage to the pancreas during the recovery process.{{cite web | work = E Medicine Health | vauthors = Balentine JR, Stöppler MC | title = Symptoms and Signs of Acute and Chronic Pancreatitis Differences | url = https://www.emedicinehealth.com/pancreatitis/symptom.htm }} Patients whose pancreatitis can be linked to alcoholism are known to have a much higher risk of recurrence.

Severe acute pancreatitis has mortality rates around 2–9%, higher where necrosis of the pancreas has occurred.{{cite journal | vauthors = Munoz A, Katerndahl DA | title = Diagnosis and management of acute pancreatitis | journal = American Family Physician | volume = 62 | issue = 1 | pages = 164–174 | date = July 2000 | pmid = 10905786 | url = http://www.aafp.org/afp/2000/0701/p164.html | url-status = live | archive-url = https://web.archive.org/web/20121008115632/http://www.aafp.org/afp/2000/0701/p164.html | archive-date = 2012-10-08 }}

Several scoring systems are used to predict the severity of an attack of pancreatitis. They each combine demographic and laboratory data to estimate severity or probability of death. Examples include APACHE II, Ranson, BISAP, and Glasgow. The Modified Glasgow criteria suggests that a case be considered severe if at least three of the following are true:{{cite journal | vauthors = Corfield AP, Cooper MJ, Williamson RC, Mayer AD, McMahon MJ, Dickson AP, Shearer MG, Imrie CW | title = Prediction of severity in acute pancreatitis: prospective comparison of three prognostic indices | journal = Lancet | volume = 2 | issue = 8452 | pages = 403–407 | date = August 1985 | pmid = 2863441 | doi = 10.1016/S0140-6736(85)92733-3 | s2cid = 46327341 }}

• Age > 55 years
• Blood levels:
• PO2 oxygen < 60 mmHg or 7.9 kPa
• White blood cells > 15,000/μL
• Calcium < 2 mmol/L
• Blood urea nitrogen > 16 mmol/L
• Lactate dehydrogenase (LDH) > 600iu/L
• Aspartate transaminase (AST) > 200iu/L
• Albumin < 3.2g/L
• Glucose > 10 mmol/L

This can be remembered using the mnemonic PANCREAS:

• PO2 oxygen < 60 mmHg or 7.9 kPa
• Age > 55
• Neutrophilia white blood cells > 15,000/μL
• Calcium < 2 mmol/L
• Renal function (BUN) > 16 mmol/L
• Enzymes lactate dehydrogenase (LDH) > 600iu/L aspartate transaminase (AST) > 200iu/L
• Albumin < 3.2g/L
• Sugar glucose > 10 mmol/L

The BISAP score (blood urea nitrogen level >25 mg/dL (8.9 mmol/L), impaired mental status, systemic inflammatory response syndrome, age over 60 years, pleural effusion) has been validated as similar to other prognostic scoring systems.{{cite journal | vauthors = Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC | title = Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis | journal = The American Journal of Gastroenterology | volume = 105 | issue = 2 | pages = 435–41; quiz 442 | date = February 2010 | pmid = 19861954 | doi = 10.1038/ajg.2009.622 | s2cid = 41655611 }}

Globally the incidence of acute pancreatitis is 5 to 35 cases per 100,000 people. The incidence of chronic pancreatitis is 4–8 per 100,000 with a prevalence of 26–42 cases per 100,000.{{cite book|title=Harrison's Principles of Internal Medicine|isbn=978-0071802161|year=2015|edition= 19th|chapter=Chapter 370 Approach to the Patient with Pancreatic Disease| vauthors = Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J |publisher=McGraw Hill Professional }} In 2013 pancreatitis resulted in 123,000 deaths up from 83,000 deaths in 1990.

In adults in the United Kingdom, the estimated average total direct and indirect costs of chronic pancreatitis is roughly £79,000 per person on an annual basis.{{cite journal | vauthors = Hall TC, Garcea G, Webb MA, Al-Leswas D, Metcalfe MS, Dennison AR | title = The socio-economic impact of chronic pancreatitis: a systematic review | journal = Journal of Evaluation in Clinical Practice | volume = 20 | issue = 3 | pages = 203–207 | date = June 2014 | pmid = 24661411 | doi = 10.1111/jep.12117 }} Acute recurrent pancreatitis and chronic pancreatitis occur infrequently in children, but are associated with high healthcare costs due to substantial disease burden. Globally, the estimated average total cost of treatment for children with these conditions is approximately $40,500/person/year.{{cite journal | vauthors = Ting J, Wilson L, Schwarzenberg SJ, Himes R, Barth B, Bellin MD, Durie PR, Fishman DS, Freedman SD, Gariepy CE, Giefer MJ, Gonska T, Husain SZ, Kumar S, Morinville VD, Lowe ME, Ooi CY, Pohl JF, Troendle D, Usatin D, Werlin SL, Wilschanski M, Heyman MB, Uc A | title = Direct Costs of Acute Recurrent and Chronic Pancreatitis in Children in the INSPPIRE Registry | journal = Journal of Pediatric Gastroenterology and Nutrition | volume = 62 | issue = 3 | pages = 443–449 | date = March 2016 | pmid = 26704866 | pmc = 4767646 | doi = 10.1097/MPG.0000000000001057 }}

Fatty foods may cause canine pancreatitis in dogs.

{{cite web|title=8 Toxic Foods for Dogs|url=http://www.consumerreports.org/pet-products/toxic-foods-for-dogs/| vauthors = Calderone J |date=July 30, 2016|work=Consumer Reports|url-status=live|archive-url=https://web.archive.org/web/20170211155407/http://www.consumerreports.org/pet-products/toxic-foods-for-dogs/|archive-date=February 11, 2017}}

• Exocrine pancreatic insufficiency
• Chronic pancreatitis

{{Reflist}}

{{Commons category}}

• [https://www.ncbi.nlm.nih.gov/books/NBK84399/ GeneReviews/NCBI/NIH/UW entry on PRSS1-Related Hereditary Pancreatitis]
• {{cite web | url = https://medlineplus.gov/pancreatitis.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Pancreatitis }}

{{Medical condition classification and resources

| DiseasesDB = 24092

| ICD10 = {{ICD10|K|85||k|80}}, {{ICD10|K|86|0|k|80}}–{{ICD10|K|86|1|k|80}}

| ICD9 = {{ICD9|577.0}}–{{ICD9|577.1}}

| ICDO =

| OMIM = 167800

| MedlinePlus = 001144

| eMedicineSubj = emerg

| eMedicineTopic = 354

| MeshID = D010195

|GeneReviewsName=Pancreatitis

|GeneReviewsNBK=NBK190101

}}

{{Digestive system diseases}}

{{Alcohol and health}}

{{Authority control}}

Category:Abdominal pain

Category:Herpes simplex virus–associated diseases

Category:Inflammations

Category:Metabolic disorders

Category:Pancreas disorders

Category:Wikipedia emergency medicine articles ready to translate

Category:Wikipedia medicine articles ready to translate