TITLE: ACUTE PANCREATITIS
AUTHORS: TYLER STEVENS, MD --
Department of Gastroenterology and Hepatology
  DARWIN L. CONWELL , MD --
Department of Gastroenterology and Hepatology
PUBLISHED: APRIL 8, 2005
Table 1:
Causes of Acute Pancreatitis (% of Cases)
  • Gallstones: 45%
  • Alcohol: 35%
  • Other 10%
    • Medications
    • Hypercalcemia
    • Hypertriglyceridemia
    • Obstructive
    • Post-ERCP
    • Hereditary
    • Trauma
    • Viral Vascular/ischemic
    • Postcardiac bypass
  • Idiopathic: 10%

ERCP=endoscopic retrograde cholangiopancreatography

 

Table 2:
Medications Associated With Acute Pancreatitis
  • Sulfa-containing drugs (bactrim, sulfasalazine)
  • 6-Mercaptopurine, azathioprine
  • Valproic acid
  • Tetracycline, metronidazole
  • Pentamidine
  • Didanosine
  • Diuretics (furosemide, thiazides)
  • NSAIDs (salicylates, sulindac)

NSAID = nonsteroidal anti-inflammatory agent

 

Table 3:
Differential Diagnosis of Elevated Amylase
  • Mesenteric ischemia
  • Intestinal obstruction
  • Visceral perforation
  • Biliary colic
  • Renal failure
  • Salivary gland disease
  • Tubo-ovarian abscess
  • Macroamylasemia
  • Fulminant hepatic failure

 

Table 4:
Mortality of Acute Pancreatitis
Type
Mortality Rate
Interstitial AP
<1%
Necrotizing AP
Sterile
10%
Infected
30%
  

 

Table 5:
BALTHAZAR Grading System for Severity
of Acute Pancreatitis According to CT Criteria
Grade
CT Findings
(Contrast or Noncontrast)
A
 Normal pancreas
B
 Focal or diffuse glandular enlargement, irregular contour of the gland, heterogeneous attenuation, no peripancreatic inflammation
C
 Same findings as Grade B, with peripancreatic inflammation
D
 Same findings as Grade C, with a single fluid collection
E
 Same findings as Grade C, with multiple fluid collections or abscess formation
Adapted from Balthazar EJ, et al. Radiology. 1990:174:331.

 

Table 6:
Ranson Criteria for Predicting
Mortality in Acute Pancreatitis
At Admission
During Initial 48 Hours
Age >55 yrs Hematocrit falls by >10 mg/dl
WBC >16,000/cc BUN increases by >5 mg/dl
LDH >350 IU/L Calcium <8 mg/dL
AST >250IU/L PaO2 <60 mmHg
Glucose >200 mg/dL Base deficit >4 mg/dl
   Fluid sequestration >6 L
WBC = white blood cell; BUN = blood urea nitrogen; LDH = lactate dehydrogenase; AST = aspartate aminotransferase; PaO2 = partial pressure of carbon dioxide, arterial.
  

This information is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition.

In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this web site.
Copyright 2005 The Cleveland Clinic Foundation