Acute Pancreatitis

🔍 When to Suspect

Sudden onset of severe, constant, "boring" epigastric pain that frequently radiates to the back, associated with nausea, vomiting, and systemic distress

From the full topic in The Ocean Library: Acute Pancreatitis

🧭 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".

• Often eased by sitting forward and worsened by lying flat.

• Usually accompanied by nausea, vomiting and systemic distress.

In the UK, gallstones and alcohol together account for around 80% of cases. Do not assume alcohol is the cause simply because a person drinks.

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

• Hereditary causes

• A proportion remain idiopathic

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

• Characteristic findings on imaging

Most episodes are mild and self-limiting, but a significant minority are severe and life-threatening.

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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