Pancreatitis: Difference between revisions

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Latest revision as of 08:11, 24 August 2025

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{{short description|Inflammation of the pancreas}}

[[nl:Pancreatitis]]

{{About|the medical condition|other uses|Pancreatitis (disambiguation)}}

'''Pancreatitis''' is inflammation of the [[pancreas]]. It is usually divided into two categories, [[Pancreatitis#Acute pancreatitis|acute pancreatitis]] and [[Pancreatitis#Chronic pancreatitis|chronic pancreatitis]].

{{cs1 config|name-list-style=vanc|display-authors=6}}

{{Infobox medical condition (new)

| name = Pancreatitis

| image = Illu pancrease.svg

| caption = The [[pancreas]] and surrounding [[organ (anatomy)|organs]]

| field = {{hlist|[[Gastroenterology]]|[[general surgery]]}}

| symptoms = {{hlist|[[epigastrium|Pain in the upper abdomen]]|[[nausea]]|[[vomiting]]|[[fever]]|[[steatorrhea|fatty stool]]<ref name=NID2012/>}}

| complications = Infection, bleeding, [[diabetes mellitus]],<ref name=NID2012/> pancreatic cancer, kidney failure, breathing problems, malnutrition<ref>{{cite news |title=Patient Care & Health Information > Diseases & Conditions: Pancreatitis |url= https://www.mayoclinic.org/diseases-conditions/pancreatitis/symptoms-causes/syc-20360227 |publisher=[[Mayo Clinic]] |date=4 June 2022}}</ref>

| onset =

| duration = Short or long term<ref name=NID2012/>

| causes = {{hlist|[[Gallstone]]|heavy [[alcohol (drug)|alcohol]] use|direct trauma|certain medications|[[mumps]]<ref name=NID2012/>}}

| risks = Smoking<ref name=Lancet2015/><ref name=Yad2013/>

| diagnosis = Based on symptoms, blood [[amylase]] or [[lipase]]<ref name=Gastroenterology2007/><ref name=NID2012/>

| differential =

| prevention =

| treatment = [[Intravenous fluid]]s, [[pain medication]], [[antibiotic]]s<ref name=NID2012/>

| medication =

| prognosis =

| frequency = 8.9 million (2015)<!-- incidence --><ref name=GBD2015Pre/>

| deaths = 132,700 (2015)<ref name=GBD2015De/>

}}

<!-- Definition and symptoms -->

'''Pancreatitis''' is a condition characterized by [[inflammation]] of the [[pancreas]].<ref name=NID2012/> The pancreas is a large organ behind the [[stomach]] that produces [[digestive enzyme]]s and a number of [[hormone]]s.<ref name=NID2012/> There are two main types, [[acute pancreatitis]] and [[chronic pancreatitis]].<ref name=NID2012/> Signs and symptoms of pancreatitis include [[epigastrium|pain in the upper abdomen]], [[nausea]], and [[vomiting]].<ref name="NID2012" /> The pain often goes into the back and is usually severe.<ref name="NID2012" /> In acute pancreatitis, a [[fever]] may occur; symptoms typically resolve in a few days.<ref name="NID2012" /> In chronic pancreatitis, weight loss, [[steatorrhea|fatty stool]], and [[diarrhea]] may occur.<ref name="NID2012" /><ref name="Gastroenterology2007">{{cite journal | vauthors = Witt H, Apte MV, Keim V, Wilson JS | title = Chronic pancreatitis: challenges and advances in pathogenesis, genetics, diagnosis, and therapy | journal = Gastroenterology | volume = 132 | issue = 4 | pages = 1557–1573 | date = April 2007 | pmid = 17466744 | doi = 10.1053/j.gastro.2007.03.001 | doi-access = free }}</ref> Complications may include infection, bleeding, [[diabetes mellitus]], or problems with other organs.<ref name="NID2012">{{cite web|title=Pancreatitis|url=http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/pancreatitis/Pages/facts.aspx|website=The National Institute of Diabetes and Digestive and Kidney Diseases|publisher=National Institutes of Health|access-date=1 March 2015|date=August 16, 2012|url-status=dead|archive-url=https://web.archive.org/web/20150307095945/http://www.niddk.nih.gov/health-information/health-topics/digestive-diseases/pancreatitis/Pages/facts.aspx|archive-date=7 March 2015}}</ref>

<!-- Causes and diagnosis -->

It is said that pancreatitis (acute and chronic) accounts for 3% of all cases of [[abdominal pain]] in the U.K. It can be a serious condition, with very significant mortality figures if it is severe.

The two most common causes of acute pancreatitis are a [[gallstone]] blocking the [[common bile duct]] after the [[pancreatic duct]] has joined; and heavy [[alcohol (drug)|alcohol]] use.<ref name=NID2012/> Other causes include direct trauma, certain medications, infections such as [[mumps]], and [[tumor]]s.<ref name=NID2012/> Chronic pancreatitis may develop as a result of acute pancreatitis.<ref name=NID2012/> It is most commonly due to many years of heavy alcohol use.<ref name=NID2012/> Other causes include [[hyperlipidemia|high levels of blood fats]], [[hypercalcemia|high blood calcium]], some medications, and certain [[genetic disorder]]s, such as [[cystic fibrosis]], among others.<ref name="NID2012" /> [[tobacco smoking|Smoking]] increases the risk of both acute and chronic pancreatitis.<ref name="Lancet2015" /><ref name="Yad2013">{{cite journal | vauthors = Yadav D, Lowenfels AB | title = The epidemiology of pancreatitis and pancreatic cancer | journal = Gastroenterology | volume = 144 | issue = 6 | pages = 1252–1261 | date = June 2013 | pmid = 23622135 | pmc = 3662544 | doi = 10.1053/j.gastro.2013.01.068 }}</ref> Diagnosis of acute pancreatitis is based on a threefold increase in the blood of either [[amylase]] or [[lipase]].<ref name="NID2012" /> In chronic pancreatitis, these tests may be normal.<ref name="NID2012" /> [[Medical imaging]] such as [[ultrasound]] and [[CT scan]] may also be useful.<ref name="NID2012" />

<!-- Prevention and treatment -->

==Acute pancreatitis==

Acute pancreatitis is usually treated with [[intravenous fluid]]s, [[pain medication]], and sometimes [[antibiotic]]s.<ref name=NID2012/> For patients with severe pancreatitis who cannot tolerate normal oral food consumption, a [[nasogastric tube]] is placed in the stomach.<ref name=NID2012/><ref name=":2">{{cite journal | vauthors = Tenner S, Vege SS, Sheth SG, Sauer B, Yang A, Conwell DL, Yadlapati RH, Gardner TB | title = American College of Gastroenterology Guidelines: Management of Acute Pancreatitis | journal = The American Journal of Gastroenterology | volume = 119 | issue = 3 | pages = 419–437 | date = March 2024 | pmid = 38857482 | doi = 10.14309/ajg.0000000000002645 }}</ref> A procedure known as an [[endoscopic retrograde cholangiopancreatography]] (ERCP) may be done to examine the distal common bile duct and remove a gallstone if present.<ref name=NID2012/> In those with gallstones the [[gallbladder]] is often also [[Cholecystectomy|removed]].<ref name=NID2012/> In chronic pancreatitis, in addition to the above, temporary feeding through a nasogastric tube may be used to provide adequate nutrition.<ref name=NID2012/> Long-term dietary changes and [[pancreatic enzyme replacement]] may be required.<ref name=NID2012/> Occasionally, surgery is done to remove parts of the pancreas.<ref name=NID2012/>

<!-- Epidemiology and history -->

===Features===

Globally, in 2015 about 8.9 million cases of pancreatitis occurred.<ref name=GBD2015Pre>{{cite journal | title = Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1545–1602 | date = October 2016 | pmid = 27733282 | pmc = 5055577 | doi = 10.1016/S0140-6736(16)31678-6 | vauthors = Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, Carter A, Casey DC, Charlson FJ, Chen AZ, Coggeshall M, Cornaby L, Dandona L, Dicker DJ, Dilegge T, Erskine HE, Ferrari AJ, Fitzmaurice C, Fleming T, Forouzanfar MH, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Johnson CO, Kassebaum NJ, Kawashima T, Kemmer L }}</ref> This resulted in 132,700 deaths, up from 83,000 deaths in 1990.<ref name=GBD2015De>{{cite journal | title = Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015 | journal = Lancet | volume = 388 | issue = 10053 | pages = 1459–1544 | date = October 2016 | pmid = 27733281 | pmc = 5388903 | doi = 10.1016/s0140-6736(16)31012-1 | vauthors = Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, Coggeshall M, Dandona L, Dicker DJ, Erskine HE, Ferrari AJ, Fitzmaurice C, Foreman K, Forouzanfar MH, Fraser MS, Fullman N, Gething PW, Goldberg EM, Graetz N, Haagsma JA, Hay SI, Huynh C, Johnson CO, Kassebaum NJ, Kinfu Y, Kulikoff XR }}</ref><ref name=GDB2013>{{cite journal | vauthors = ((GBD 2013 Mortality Causes of Death Collaborators)) | title = Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013 | journal = Lancet | volume = 385 | issue = 9963 | pages = 117–171 | date = January 2015 | pmid = 25530442 | pmc = 4340604 | doi = 10.1016/S0140-6736(14)61682-2 }}</ref> Acute pancreatitis occurs in about 30 per 100,000 people a year.<ref name=Lancet2015>{{cite journal | vauthors = Lankisch PG, Apte M, Banks PA | title = Acute pancreatitis | journal = Lancet | volume = 386 | issue = 9988 | pages = 85–96 | date = July 2015 | pmid = 25616312 | doi = 10.1016/S0140-6736(14)60649-8 | hdl-access = free | s2cid = 25600369 | hdl = 1959.4/unsworks_49570 | url = https://unsworks.unsw.edu.au/bitstreams/b0928ca3-6d41-48b9-ac8e-24c08d9ee61b/download }}</ref> New cases of chronic pancreatitis develop in about 8 per 100,000 people a year and currently affect about 50 per 100,000 people in the United States.<ref name=Mun204/> It is more common in men than women.<ref name=NID2012/> Often chronic pancreatitis starts between the ages of 30 and 40 and is rare in children.<ref name=NID2012/> Acute pancreatitis was first described on autopsy in 1882 while chronic pancreatitis was first described in 1946.<ref name=Mun204>{{cite journal | vauthors = Muniraj T, Aslanian HR, Farrell J, Jamidar PA | title = Chronic pancreatitis, a comprehensive review and update. Part I: epidemiology, etiology, risk factors, genetics, pathophysiology, and clinical features | journal = Disease-a-Month | volume = 60 | issue = 12 | pages = 530–550 | date = December 2014 | pmid = 25510320 | doi = 10.1016/j.disamonth.2014.11.002 }}</ref>

*Severe abdominal pain often radiating through to the back.

*Nausea, vomiting and loss of appetite.

*Severe illness, sometimes requiring admission to [[intensive care]] and sometimes fatal.

*Recovery may be followed by development of [[pancreatic pseudocyst]], [[pancreatic dysfunction]] (malabsorption) or [[diabetes]].

==Signs and symptoms==

===Causes===

The most common symptoms of pancreatitis are severe [[epigastrium|upper abdominal]] or [[left upper quadrant]] burning pain [[referred 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 rate|Heart]] and [[respiratory rate]]s are often elevated. The abdomen is usually [[tenderness (medicine)|tender]] but to a lesser degree than the pain itself. As is common in abdominal disease, [[bowel sounds]] may be reduced from reflex [[ileus|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 enzyme]]s hindering [[digestion]].{{citation needed|date=July 2022}}

*Gallstones

*Alcohol

*[[Mumps]]

*[[Hypercalcaemia]]

*Idiopathic (unknown)

*[[Fat necrosis]]

===Complications===

The most common causes of pancreatitis, accounting for more than 85% of all cases of pancreatitis in Western countries are chronic [[alcoholism]] and [[gallstone]]s. Other causes include [[trauma]] (as from a steering wheel in an automobile accident), [[infection]] (the [[mumps]] virus being the most common), [[drugs]] (the [[diuretic]]s [[Lasix]] and [[thiazide]]s, and some [[antiretroviral]]s are common causes), and [[cancer]].

Early complications include [[Shock (circulatory)|shock]], infection, [[systemic inflammatory response syndrome]], low blood calcium, high blood glucose, and [[dehydration]]. Blood loss, dehydration, and [[third spacing|fluid leaking]] into the [[abdominal cavity]] ([[ascites]]) can lead to [[kidney failure]]. Respiratory complications are often [[acute respiratory distress syndrome|severe]]. [[Pleural effusion]] is usually present. Shallow breathing from pain can lead to [[atelectasis|lung collapse]]. Pancreatic enzymes may attack the lungs, causing [[pneumonitis|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.<ref>{{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 }}</ref>

Late complications include recurrent pancreatitis and the development of [[pancreatic pseudocyst]]s—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.<ref name="A">{{EMedicine|article|181264|Pancreatic abscess}}</ref>

Gallstones that travel down the common [[bile duct]] and which subsequently get stuck in the [[Ampulla of Vater]] can cause obstruction in the outflow of pancreatic juices from the pancreas into the [[duodenum]]. The backflow of these digestive juices causes [[chemical lysis|lysis]] (dissolving) of pancreatic cells and subsequent pancreatitis.

===Pathogenesis=Causes==

About 80 percent of pancreatitis cases are caused by [[gallstone]]s or [[alcohol (drug)|alcohol]]. [[Choledocholithiasis]] (gallstones in the [[bile duct]]) are the single most common cause of acute pancreatitis,<ref>{{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 }}</ref> and [[alcoholism]] is the single most common cause of chronic pancreatitis.<ref>{{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 }}</ref><ref>{{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 }}

The [[exocrine]] pancreas produces a variety of [[enzyme]]s, such as [[protease]]s, [[lipase]]s and [[saccharidase]]s. These enzymes conntribute to food [[digestion]] by breaking down food tissues. In acute pancreatitis, the worst offender among these enzymes may well be the protease [[trypsinogen]] which converts to the active [[trypsin]] which is most responsible for auto-digestion of the pancreas which causes the pain and complications of pancreatitis.

* {{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}}</ref><ref>{{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 }}</ref><ref>{{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 }}</ref><ref>{{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 }}</ref> Serum [[triglyceride]] levels greater than 1000&nbsp;mg/dL (11.29&nbsp;mmol/L, i.e. [[hyperlipidemia]]) is another cause.<ref>{{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 }}</ref>

The [[list of medical mnemonics|mnemonic]] "GET SMASHED" is often used to help [[clinician]]s and [[medical student]]s remember the common causes of pancreatitis: '''G'''allstones, '''E'''thanol, '''T'''rauma, [[steroid|'''S'''teroids]], '''M'''umps, [[autoimmune disease|'''A'''utoimmune]], [[Scorpion sting|'''S'''corpion sting]], '''H'''yperlipidemia, [[hypothermia]] or [[hyperparathyroidism]], [[endoscopic retrograde cholangiopancreatography|'''E'''RCP]], '''D'''rugs (commonly [[azathioprine]], [[valproic acid]], [[liraglutide]]).<ref>{{cite web |url= https://radiopaedia.org/articles/causes-of-pancreatitis-mnemonic | title= Causes of pancreatitis (mnemonic)

===Diagnosis===

| website= Radiopaedia.org |access-date= 26 June 2021}}</ref>

Important biochemical markers for pancreatitis are [[serum]] [[amylase]] and [[lipase]] levels. Amylase and lipase levels can rise to more than a hundred times normal levels in cases of acute pancreatitis.

===Medications===

In addition, in predicting the prognosis, there are several factors that are known to impact negatively on survival: the more of these that are present, the graver the patient's condition is (these are known as the ''Ranson'' or ''Imrie'' criteria):

There are seven classes of medications associated with acute pancreatitis: [[statins]], [[ACE inhibitors]], [[oral contraceptive]]s/[[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}}

*age greater than 55 years at admission or diagnosis

*a white blood cell count of > 16,000/µl at admission or diagnosis

*blood glucose > 11 mmol/L (>200 mg/dL) at admission or diagnosis

*serum LDH > 400 IU/L at admission or diagnosis

*serum AST >256 IU/L at admission or diagnosis

*fall in hematocrit by more than 10 percent in the first 48 hours of admission

*fluid deficit of > 4 L in the first 48 hours of admission

*hypocalcemia (serum calcium < 1.0 mmol/L (<8.0 mg/dL) in the first 48 hours of admission

*hypoxemia (P_O₂ < 60 mmHg in the first 48 hours of admission

*increase in BUN to >1.98 mmol/L (>5 mg/dL) after IV fluid hydration in the first 48 hours of admission

*hypoalbuminemia (albuminm <32 g/L (<3.2 g/dL) in the first 48 hours of admission

*Acute physiology and chronic health evaluation (APACHE II) score > 12 points

*hemorrhagic peritoneal fluid

*obesity

*indicators of organ failure

*hypotension (SBP <90 mmHG) or tachycardia > 130 bpm

*P_O₂ <60 mmHg

*Oliguria (<50 mL?h) or increasing BUN and creatinine

*serum calcium < 1.90 mmol/L (<8.0 mg/dL) or serum albumin <33 g/L (<3.2.g/dL)>

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.<ref>{{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 }}</ref> Various oral hypoglycemic agents are associated with pancreatitis including [[metformin]], but [[GLP-1|glucagon-like peptide-1]] mimetics such as [[exenatide]] are more strongly associated with pancreatitis by promoting inflammation in combination with a high-fat diet.<ref>{{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" }}</ref>

===Classification by severity===

Acute pancreatitis can be further divided in mild and severe pancreatitis. Mostly the Atlanta classification (1992) is used. In severe pancreatitis serious amount of necrosis determine the further clinical outcome. About 20% of the acute pancreatitis are severe with a mortality of about 20%. This is an important classification as severe pancreatits will need intensive care therapy whereas mild pancreatits can be treated on the common ward.

Atypical [[antipsychotic]]s such as [[clozapine]], [[risperidone]], and [[olanzapine]] can also cause pancreatitis.<ref>{{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 }}</ref>

Necrosis will be followed by an systemic inflammation response syndrom (SIRS) and will determin the immediate clinical course. The further clinical course is then determined by bacterial infection. SIRS is the cause bacterial translocation from the patients colon.

===Infection===

There are several ways to help distinguishe between these two forms. One is the above mentioned Ranson Score.

A number of infectious agents have been recognized as causes of pancreatitis including:<ref>{{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 }}</ref><ref>{{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 }}</ref><ref>{{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}}</ref>

* [[Virus]]es

** [[Coxsackie virus]]

** [[Cytomegalovirus]]

** [[Hepatitis B]]

** [[Herpes simplex virus]]

** [[Mumps]]

** [[Varicella-zoster virus]]

* [[Bacteria]]

** [[Legionella]]

** [[Leptospira]]

** [[Mycoplasma]]

** [[Salmonella]]

* [[Fungus|Fungi]]

** [[Aspergillus]]

* [[Parasite]]s

** [[Ascaris]]

** [[Cryptosporidium]]

** [[Toxoplasma]]

===TreatmentOther===

Other common causes include [[trauma (medicine)|trauma]], [[autoimmune pancreatitis|autoimmune disease]], [[Hypercalcemia|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&nbsp;2]] is associated with a 2.8-fold higher risk.<ref>{{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 }}</ref>

*Supportive for shock.

*Pain relief

*Enzyme inhibitors are not proven to work.

*While often severe, the disease is essentially self limiting.

Less common causes include [[pancreatic cancer]], pancreatic duct stones,<ref>{{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 }}</ref> [[vasculitis]] (inflammation of the small [[blood vessels]] in the pancreas), and [[porphyria]]—particularly [[acute intermittent porphyria]] and [[erythropoietic protoporphyria]].{{citation needed|date=July 2022}}

In the management of acute pancreatitis, the treatment is to stop feeding the patient, giving him nothing by mouth, giving [[intravenous]] fluids to prevent [[dehydration]]. As the pancreas is stimulated to secrete [[enzyme]]s by the presence of food in the stomach, having no food pass through the system allows the pancreas to rest.

There is an [[hereditary pancreatitis|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]].<ref>{{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}}</ref>

==Chronic pancreatitis==

Chronic pancreatitis can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption. The causes of relapsing chronic pancreatitis asre similar to those of acute pancreatits, though gallstone-associated pancreatitis is predominantly acute or relapsing-acute in nature, and more cases of chronic pancreatitis are of undetermined or idiopathic origin.

==Diagnosis==

Patients with chronic pancreatitis can present with persistent abdominal pain or steatorrhea.

[[File:Pankreatitis exsudativ CT axial.jpg|thumb|Acute exudative pancreatitis on CT scan]] [[File:CalcifiedPanDucStoneandSomefluid.png|thumb|Calcified pancreatic duct stones with some free intra-abdominal fluid]]

The differential diagnosis for pancreatitis includes but is not limited to [[cholecystitis]], [[choledocholithiasis]], [[Peptic ulcer#Complications|perforated peptic ulcer]], [[bowel infarction]], [[bowel obstruction|small bowel obstruction]], [[hepatitis]], and [[mesenteric ischemia]].<ref name=":0">{{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}}</ref>

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

Among American adults, chronic pancreatitis most often occurs from the cumulative pancreatic destruction caused by repeated alcohol-induced episodes of acute pancreatitis. Cystic fibrosis is the most common cause of chronic pancreatitis in children. In up to one quarter of cases, no cause can be found. In other parts of the world, severe protein-calorie malnutrition is a common cause.

* Characteristic acute onset of [[Epigastrium|epigastric]] or vague abdominal pain that may [[Referred pain|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 scan|CT]], [[Magnetic resonance imaging|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 [[Sensitivity and specificity|specificity]] and has a longer half life.<ref name=":1"/> 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]], [[IgG4-related disease|immunoglobulin G4]], [[rheumatoid factor]], and [[anti-nuclear antibody]].<ref>{{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}}</ref>

Serum amylase and lipase may well not be elevated in chronic pancreatitis. Pancreatic calcification can often be seen on x-ray.

For imaging, abdominal ultrasound is convenient, simple, non-invasive, and inexpensive.<ref>{{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 }}</ref> It is more sensitive and specific for pancreatitis from gallstones than other imaging modalities.<ref name=":1">{{Cite book|title = Hospitalist Handbook|edition = 4th|publisher = Department of Medicine University of California, San Francisco|year = 2012|pages = 224–25}}</ref> However, in 25–35% of patients the view of the pancreas can be obstructed by bowel gas making it difficult to evaluate.<ref name=":0" />

Treatment is directed, when possible, to the underlying cause, and to relief of the pain and malabsorption. Replacement pancreatic enzymes have proven effective in treating the malabsorption and steatorrhea.

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.<ref>{{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 }}</ref>

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

==Treatment==

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 [[Inpatient care|hospitalized]], at least briefly, to receive [[IV fluids]] and for clinical monitoring purposes.<ref name=":2" />

=== Pain management ===

Acute pancreatitis typically presents with severe to extreme abdominal pain.<ref name=":2" /><ref name=":3">{{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 }}</ref> 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.<ref name=":3" />

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.<ref name=":3" /><ref>{{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 }}</ref>

=== Fluid resuscitation ===

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 [[Ringer's lactate solution|lactated Ringer solution]], but [[Saline (medicine)|saline]] may also be used. Patients with acute pancreatitis of any severity are typically [[Hypovolemia|hypovolemic]] (decreased blood volume), and this hypovolemia can result in [[hypoperfusion]] of pancreatic cells. Without blood supplying them, the pancreatic cells can become [[Necrosis|necrotic]], resulting in tissue death that can become further worsened by the strong inflammatory response that occurs following necrosis.<ref name=":2" />

=== Managing infection ===

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.<ref name=":2" /> The majority of patients with pancreatitis have damage to the [[Gut barrier dysfunction|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.<ref>{{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 }}</ref>

===Mild acute pancreatitis===

The treatment of mild [[acute pancreatitis]] is successfully carried out by admission to a general hospital ward for fluid resuscitation and patient monitoring.<ref name=":2" /> 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.<ref name=":2" /><ref>{{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 | hdl = 10072/392220 | hdl-access = free }}</ref>

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.<ref name=":2" /><ref>{{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 }}</ref>

===Severe acute pancreatitis===

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.<ref name=":2" />

Patients with severe AP are often unable to receive oral nutrition, and so [[Feeding tube|nasogastric feeding tubes]] are commonly used for these patients. Feeding tubes may be used to provide calories and nutrients, combined with appropriate analgesia.<ref name=":2" /> Early enteral feeding within 48 hours of admission to the hospital has been associated with better outcomes.<ref>{{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 }}</ref>

The lungs can be inflamed as a result of the systemic inflammatory response and can manifest as [[acute respiratory distress syndrome]] (ARDS).<ref name=":2" /> 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]].<ref>{{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 }}</ref><ref>{{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|url-access=subscription }}</ref>

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 [[Endoscopic retrograde cholangiopancreatography|ERCP]] procedure or [[Cholecystectomy|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.<ref name=":2" />

If the cause of pancreatitis is alcohol, cessation of alcohol consumption and treatment for [[Alcohol dependence|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.<ref>{{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 }}</ref> Patients whose pancreatitis can be linked to alcoholism are known to have a much higher risk of recurrence.<ref name=":2" />

==Prognosis==

Severe acute pancreatitis has [[mortality rate]]s around 2–9%, higher where [[necrosis]] of the pancreas has occurred.<ref>{{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 }}</ref>

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&nbsp;II]], [[Ranson criteria|Ranson]], BISAP, and Glasgow. The Modified Glasgow criteria suggests that a case be considered severe if at least three of the following are true:<ref name="pmid2863441">{{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 }}</ref>

* Age > 55 years

* Blood levels:

** PO2 [[hypoxemia|oxygen]] < 60 mmHg or 7.9 kPa

** [[leukocytosis|White blood cells]] > 15,000/μL

** [[hypocalcemia|Calcium]] < 2&nbsp;mmol/L

** [[Blood urea nitrogen]] > 16&nbsp;mmol/L

** [[Lactate dehydrogenase]] (LDH) > 600iu/L

** [[Aspartate transaminase]] (AST) > 200iu/L

** [[hypoalbuminemia|Albumin]] < 3.2g/L

** [[hyperglycemia|Glucose]] > 10&nbsp;mmol/L

This can be remembered using the mnemonic PANCREAS:

* PO2 [[hypoxemia|oxygen]] < 60 mmHg or 7.9 kPa

* Age > 55

* Neutrophilia [[leukocytosis|white blood cells]] > 15,000/μL

* [[hypocalcemia|Calcium]] < 2&nbsp;mmol/L

* Renal function ([[Blood urea nitrogen|BUN]]) > 16&nbsp;mmol/L

* Enzymes [[lactate dehydrogenase]] (LDH) > 600iu/L [[aspartate transaminase]] (AST) > 200iu/L

* [[hypoalbuminemia|Albumin]] < 3.2g/L

* Sugar [[hyperglycemia|glucose]] > 10&nbsp;mmol/L

The BISAP score ('''b'''lood urea nitrogen level >25&nbsp;mg/dL (8.9&nbsp;mmol/L), '''i'''mpaired mental status, [[Systemic inflammatory response syndrome|'''s'''ystemic inflammatory response syndrome]], '''a'''ge over 60 years, '''p'''leural effusion) has been validated as similar to other prognostic scoring systems.<ref name="pmid19861954">{{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 }}</ref>

==Epidemiology==

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.<ref>{{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 }}</ref> In 2013 pancreatitis resulted in 123,000 deaths up from 83,000 deaths in 1990.<ref name=GDB2013/>

==Costs==

In adults in the United Kingdom, the estimated average total [[indirect costs#Indirect vs direct costs|direct and indirect costs]] of chronic pancreatitis is roughly £79,000 per person on an annual basis.<ref name="pmid24661411">{{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 }}</ref> Acute recurrent pancreatitis and chronic pancreatitis occur infrequently in children, but are associated with high healthcare costs due to substantial [[disease burden]].<ref name="pmid26704866" /> Globally, the estimated average total cost of treatment for children with these conditions is approximately $40,500/person/year.<ref name="pmid26704866">{{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 }}</ref>

==Other animals==

Fatty foods may cause [[canine pancreatitis]] in [[dog]]s.<ref>

{{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}}</ref>

== See also ==

* [[Exocrine pancreatic insufficiency]]

* [[Chronic pancreatitis]]

== References ==

{{Reflist}}

== External links ==

{{Commons category}}

*[http://digestive.niddk.nih.gov/ddiseases/pubs/pancreatitis/ NIDDK public ___domain information on pancreatitis]

* [https://www.ncbi.nlm.nih.gov/books/NBK84399/ GeneReviews/NCBI/NIH/UW entry on PRSS1-Related Hereditary Pancreatitis]

*[http://www.cnn.com/HEALTH/library/DS/00371.html gallstone pancreatitis] by CNN

* {{cite web | url = https://medlineplus.gov/pancreatitis.html | publisher = U.S. National Library of Medicine | work = MedlinePlus | title = Pancreatitis }}

*[http://www.foxhall.com/gallpanc.htm medical articles on gallstone 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]]

{{msg:Gastroenterology}}

[[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]]