Acute Pancreatitis
Acute pancreatitis is a common emergency with a wide spectrum of severity - most cases are mild and self‑limited, but a proportion develop necrosis, infected collections or multisystem organ failure requiring HDU/ICU care. Early recognition, prompt supportive care (especially fluids and analgesia), objective severity assessment and timely specialist referral are the foundations of good outcomes (NICE NG104).
Epidemiology and mortality
- UK incidence: approximately 150-420 cases per million.
- Overall mortality: approximately 5%.
- Mortality by phenotype:
- Interstitial: ≈ 3%.
- Necrotising: ≈ 17% (sterile ≈ 12%, infected ≈ 30%).
- National benchmarks: overall mortality < 10% and severe‑case mortality < 30% (UK Working Group; NICE NG104).
Aetiology - what to look for
- Most common causes: gallstones and alcohol (≈ 75-80% of cases).
- Other causes: post‑ERCP, trauma, hypertriglyceridaemia, hypercalcaemia, infections (for example mumps), autoimmune disease, medications and rare causes (for example scorpion sting).
- Up to ~20% of cases may be labelled idiopathic after initial assessment.
- Drug safety note: ask specifically about recent or new drugs, including GLP‑1 receptor agonists and dual GLP‑1/GIP agents (recent MHRA warnings), DPP‑4 inhibitors, azathioprine, valproate, some diuretics and steroids.
- If a drug is suspected to be causative, stop the suspected offending agent when pancreatitis is confirmed and report via local adverse‑event channels (MHRA Yellow Card).