American Gastroenterological Association (AGA) InstituteAGA Institute Technical Review on Acute Pancreatitis
Section snippets
Diagnosis
The diagnosis of acute pancreatitis is usually suspected based on compatible clinical features including abdominal pain, nausea, and vomiting. It has been estimated that in 40%–70% of patients, the classic pattern of pain radiation to the back is present. Pain usually reaches its peak over 30–60 minutes and persists for days or weeks. It is clear that not all patients may experience pain, or alternatively that the presence of pain may not be appreciated by the clinician caring for the patient.
Assessment of Severity
The assessment of severity is one of the most important issues in the management of acute pancreatitis. Approximately 15%–20% of patients with acute pancreatitis will develop severe disease and follow a prolonged course, typically in the setting of pancreatic parenchymal necrosis. Patients with severe acute pancreatitis associated with SIRS typically have a prolonged hospital stay and are the ones most likely to die from their disease process. The ability to quantify severity of disease allows
Determination of Etiology
The accurate determination of etiology allows a clinician to choose the most appropriate therapy for an individual patient. Advances in cross-sectional imaging and molecular biology and genetics have greatly broadened the spectrum of possible etiologies, although perhaps 10%–15% of cases of acute pancreatitis remain unexplained (Table 9). The commonest cause of acute pancreatitis in most areas of the world is gallstones (including microlithiasis), accounting for at least 35%–40% of cases77, 78
Management
The management of patients with acute pancreatitis should include closely monitored general supportive care, efforts to limit complications and appropriate treatment if complications occur, and prevention of recurrences.
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This literature review and the recommendations therein were prepared for the AGA Institute Clinical Practice and Economics Committee. The paper was approved by the Committee on February 14, 2007, and by the AGA Institute Governing Board on March 15, 2007.