Pancreatitis - Emergency Medicine Revision
Overview
Acute pancreatitis is an inflammatory disorder of the pancreas that ranges from a mild, self‑limited illness to a rapidly progressive, life‑threatening condition with local pancreatic complications and multisystem organ failure. Disease severity is driven by enzymatic autodigestion and the host inflammatory response.
The pancreas lies retroperitoneally, so peritoneal signs may be less prominent than with intraperitoneal pathology.
Key aims for the emergency clinician
- Recognise the typical presentation and important causes, including recent drug exposures.
- Rapidly confirm the diagnosis with lipase (or amylase if lipase unavailable) and use focused imaging to answer specific clinical questions. (NICE NG104)
- Initiate high‑quality resuscitation (ABCDE), provide effective analgesia, begin haemodynamic and organ support, and monitor response.
- Stratify severity clinically and escalate early for persistent organ failure or complications (Revised Atlanta definitions). (NICE NG104, RCEM)
- Avoid practices not recommended by guidelines (routine prophylactic antibiotics; routine prolonged nil‑by‑mouth) and arrange appropriate specialty referral when indicated.
Anatomy and pathophysiology
- The pancreas is retroperitoneal; inflammation causes enzyme activation within the gland leading to autodigestion, fat necrosis, haemorrhage and a systemic inflammatory response.
- Local complications include pancreatic necrosis, sterile or infected collections, pseudocyst formation, and vascular complications (pseudoaneurysm, haemorrhage).