Snapshot A 50-year-old man presents to the emergency room with acute onset epigastric pain. His past medical history includes hyperlipidemia, hypertriglyceridemia, diabetes, and alcohol abuse. His last drink was this morning and he drinks 20 beers a day. He denies any fevers or chills but reports nausea and 2 episodes of nonbloody, nonbilious vomiting. Physical exam is notable for tenderness to palpation of the epigastrium. There is no muscle spasm with percussion of the cheeks. Laboratory evaluation shows significantly elevated amylase and lipase. He is started on aggressive fluid resuscitation. Introduction Clinical definition login to view 1 more bullet ETIOLOGY Pathogenesis login to view 2 more bullets Epidemiology Risk factors login to view 19 more bullets Presentation Symptoms login to view 5 more bullets Physical exam login to view 11 more bullets imaging Abdominal radiograph login to view 3 more bullets Abdominal ultrasound login to view 7 more bullets Computed tomography (CT) of abdomen and pelvis with contrast login to view 11 more bullets CT-guided fine-needle aspiration login to view 3 more bullets Studies Diagnostic testing login to view 4 more bullets Differential Peptic ulcer disease login to view 2 more bullets DIAGNOSIS Diagnostic criteria login to view 4 more bullets Treatment Management approach login to view 2 more bullets First-line login to view 7 more bullets Other treatments login to view 7 more bullets Complications Pancreatic pseudocyst Fistula formation Pancreatic abscess Hemorrhagic pancreatitis Pleural effusions (often on the left) Chronic pancreatitis Disseminated intravascular coagulation (DIC) Prognosis Ranson criteria predict mortality Ranson CriteriaClinical SignsOn AdmissionWithin 48 hoursGlucose > 200 mg/dLAge > 55 yearsLDH > 350 IU/LWBC > 16,000/mLAST > 250 IU/dLCalcium < 8.0 mg/dLHematocrit ↓ by >10%PaO2 < 60 mmHgBase deficit > 4 mEq/LBUN ↑ by 5 mg/dLSequestered fluid > 6 LMortality3-4 signs20% mortality5-6 signs40% mortality7+ signs100% mortality Clinical Signs On Admission Within 48 hours Glucose > 200 mg/dL Age > 55years LDH > 350 IU/L WBC > 16,000/mL AST > 250 IU/dL Calcium < 8.0 mg/dL Hematocrit ↓ by >10% PaO2 < 60 mmHg Base deficit > 4 mEq/L BUN ↑ by 5 mg/dL Sequestered fluid > 6 L Mortality On Admission Within 48 hours 3-4 signs 20% mortality 5-6 signs 40% mortality 7+ signs 100% mortality