Acute pancreatitis

The diagnosis of acute pancreatitis is usually straightforward clinically and is confirmed by the demonstration of raised serum amylase or lipase. Disease severity has been defined by a consensus conference at the International Symposium on Acute Pancreatitis in Atlanta (USA) in 1992. The majority of patients with acute pancreatitis will have mild self-limiting disease that will resolve without complication. Patients with severe disease develop multiorgan dysfunction or local complications. Two phases of mortality are recognized: 50% of deaths occur in the first phase within the first week and are related to the effects of the systemic inflammatory response leading to multiorgan failure; deaths in the second phase are associated with infected complications. Over the past 30 years mortality has fallen in the early phase with improved organ support, but this has not been mirrored to the same extent by improved late-phase mortality. Aggressive investigation and management with critical care support is necessary for patients who develop severe disease. The indications for surgical intervention are well defined and many procedures may be performed minimally invasively, radiologically or by a combination of both approaches.