Acute pancreatitis

Acute pancreatitis is an inflammatory condition with a variable clinical course. Diagnosis is based upon clinical presentation, laboratory indices and imaging studies, whilst illness severity can be assessed by clinical scoring systems, such as the Ranson, Glasgow or APACHE II criteria, or by radiological assessments such as the CT severity index. Most patients develop self-limiting disease. However, a minority progress to a severe form with both local and systemic complications. Management is usually non-operative with interventional therapy reserved for those with common bile duct stones or complications such as pancreatic abscess and pseudocyst formation. This article will review the pathophysiology, assessment and treatment of acute pancreatitis, the evidence for nutritional support and the use of antibiotics, and the indications for and timing of interventional therapy.