GPAtlas🧭 When to suspect
Suspect acute pancreatitis in any patient with sudden-onset, severe, constant epigastric pain that frequently radiates through to the back. The pain is classically described as "boring", is often eased by sitting forward and worsened by lying flat, and is usually accompanied by nausea, vomiting and systemic distress.
In the UK, gallstones and alcohol together account for around 80% of cases. Other causes include hypertriglyceridaemia, hypercalcaemia, certain drugs (e.g. azathioprine, thiazides, sodium valproate, oestrogens, and – more recently recognised – GLP-1 receptor agonists), post-ERCP, abdominal trauma, infection (e.g. mumps), autoimmune disease and hereditary causes; a proportion remain idiopathic. Do not assume alcohol is the cause simply because a person drinks.
Formal diagnosis is made in secondary care and requires two of three features: characteristic abdominal pain, serum lipase or amylase ≥ 3× the upper limit of normal, and characteristic findings on imaging. Most episodes are mild and self-limiting, but a significant minority are severe and life-threatening. The key skill in primary care is twofold: recognise it early and arrange immediate emergency admission – diagnosis, risk-stratification and definitive management all happen in hospital.
| Severity (revised Atlanta) | Definition & significance |
|---|---|
| Mild | No organ failure and no local or systemic complications – the majority of cases, usually self-limiting. |
| Moderately severe | Transient organ failure (resolving within 48 hours) and/or local or systemic complications. |
| Severe | Persistent organ failure (> 48 hours, single or multiple organs); carries high mortality – around 15–20% of adults. |
Source: NICE NG104 · Revised Atlanta classification
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