Acute pancreatitis

Acute pancreatitis is one of the more common reasons for surgical admission. Most patients have mild disease and settle quickly with intravenous fluids and analgesia; the major consideration is prevention of further attacks. In 20% of patients, local inflammation initiates a systemic inflammatory response that results in a variable degree of respiratory, cardiac and renal compromise, leading to the development of multiorgan dysfunction syndrome in some patients. Fifty percent of deaths occur within the first week due to overwhelming organ failure, for which there is no specific therapy.This contribution discusses the aetiology, pathophysiology and definitions used in acute pancreatitis; the diagnosis of acute pancreatitis and the initial generic management are also discussed. This is followed by a review of evidence for specific interventions (endoscopic retrograde cholangiopancreatography, nutritional support, antibiotics, radiological imaging) and the role and indications for intervention, which are aimed primarily at the management of secondary complications.