Acute pancreatitis
Formal Definition
Inflammation of the pancreas with sudden onset, characterized by upper abdominal pain (often epigastric radiating to the back), elevated serum amylase and lipase (≥3x upper limit of normal), and imaging findings; most commonly caused by gallstones and alcohol; severity graded by Atlanta criteria and managed with supportive care, fasting, and appropriate nutritional support.
How It's Used on the Ward
Pancreatitis or inflamed pancreas — severe epigastric pain, high lipase; the patient cannot eat and you wait for it to settle down while keeping them out of multi-organ failure.
Example
"Heavy drinker, 48h of vomiting, now epigastric pain radiating to back. Lipase 1,240 U/L (normal <60), amylase 890 U/L. CT shows pancreatic inflammation with peripancreatic stranding, no necrosis. Diagnosis: acute alcoholic pancreatitis, mild by RANSON criteria (0-1). NPO initially, IV fluids, pain control. Diet to advance as tolerated once pain improves and lipase trending down."
Clinical Context
Atlanta classification: mild (no organ failure, no local complications) → usually resolves in 1 week; moderate (transient organ failure <48h, local complications like necrosis, pseudocyst) → longer stay; severe (persistent organ failure >48h, >30% pancreatic necrosis) → ICU, high mortality. RANSON and APACHE II for severity at admission; BISAP for early mortality prediction. Gallstone pancreatitis: check LFTs (ALP/ALT rising → high suspicion), order EUS or MRCP if biliary obstruction suspected. Nutrition: mild → advance to oral diet when pain improving, typically low-fat; severe → enteral nutrition via nasojejunal tube (TPN only if enteral not possible). Persistent organ failure = main driver of mortality.