Acute pancreatitis

1437:(Acute Physiology and Chronic Health Evaluation) indices. Most, but not all studies report that the Apache score may be more accurate. In the negative study of the APACHE-II, the APACHE-II 24-hour score was used rather than the 48-hour score. In addition, all patients in the study received an ultrasound twice which may have influenced allocation of co-interventions. Regardless, only the APACHE-II can be fully calculated upon admission. As the APACHE-II is more cumbersome to calculate, presumably patients whose only laboratory abnormality is an elevated lipase or amylase do not need assessment with the APACHE-II; however, this approach is not studied. The APACHE-II score can be calculated at 1064: 37: 299:(most common, occurring in up to 25% of all cases, typically after 4–6 weeks) and phlegmon/abscess formation, splenic artery pseudoaneurysms, hemorrhage from erosions into splenic artery and vein, thrombosis of the splenic vein, superior mesenteric vein and portal veins (in descending order of frequency), duodenal obstruction, common bile duct obstruction, progression to chronic pancreatitis, pancreatic ascites, pleural effusion, sterile/infected pancreatic necrosis. 828: 896:. A hallmark of acute pancreatitis is a manifestation of the inflammatory response, namely the recruitment of neutrophils to the pancreas. The inflammatory response leads to the secondary manifestations of pancreatitis: hypovolemia from capillary permeability, acute respiratory distress syndrome, disseminated intravascular coagulations, renal failure, cardiovascular failure, and gastrointestinal hemorrhage. 1150:(MRI) has become increasingly valuable as a tool for the visualization of the pancreas, particularly of pancreatic fluid collections and necrotized debris. Additional utility of MRI includes its indication for imaging of patients with an allergy to CT's contrast material, and an overall greater sensitivity to hemorrhage, vascular complications, pseudoaneurysms, and venous thrombosis. 937:, based on the presence of at least 2 of 3 criteria: abdominal pain, elevated serum lipase or amylase, and abdominal imaging findings consistent with acute pancreatitis. Additional blood studies are used to identify organ failure, offer prognostic information, and determine if fluid resuscitation is adequate and whether endoscopic retrograde cholangiopancreatography is necessary. 1042:"It is usually not necessary to measure both serum amylase and lipase. Serum lipase may be preferable because it remains normal in some nonpancreatic conditions that increase serum amylase including macroamylasemia, parotitis, and some carcinomas. In general, serum lipase is thought to be more sensitive and specific than serum amylase in the diagnosis of acute pancreatitis" 1178: 863:), which activate trypsinogen to trypsin. The active form trypsin then leads to further activation of other molecules of trypsinogen. The activation of these digestive enzymes lead to inflammation, edema, vascular injury, and even cellular death. The death of pancreatic cells occurs via two main mechanisms: 1293:(TPN) to early, post-pyloric enteral feeding (in which a feeding tube is endoscopically or radiographically introduced to the third portion of the duodenum). The advantage of enteral feeding is that it is more physiological, prevents gut mucosal atrophy, and is free from the side effects of TPN (such as 1448:

2006: "The two tests that are most helpful at admission in distinguishing mild from severe acute pancreatitis are APACHE-II score and serum hematocrit. It is recommended that APACHE-II scores be generated during the first 3 days of hospitalization and thereafter as needed to help in this distinction.

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Imaging – A triple phase abdominal CT and abdominal ultrasound are together considered the gold standard for the evaluation of acute pancreatitis. Other modalities including the abdominal x-ray lack sensitivity and are not recommended. An important caveat is that imaging during the first 12 hours may

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which regulate apoptosis and have important anti-necrosis functions during pancreatitis: preventing trypsinogen activation, preventing ATP depletion through inhibiting polyADP-ribose polymerase, and by inhibiting the inhibitors of apoptosis (IAPs). If, however, the caspases are depleted due to either

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Acute pancreatitis patients recover in majority of cases. Some may develop abscess, pseudocyst or duodenal obstruction. In 5 percent cases, it may result in acute respiratory distress syndrome (ARDS), disseminated intravascular coagulation DIC. Acute pancreatitis can be further divided into mild and

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pressure. However, no clinical studies suggest that morphine can aggravate or cause pancreatitis or cholecystitis. In addition, meperidine has a short half-life and repeated doses can lead to accumulation of the metabolite normeperidine, which causes neuromuscular side effects and, rarely, seizures.

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Most, but not all individual studies support the superiority of the lipase. In one large study, there were no patients with pancreatitis who had an elevated amylase with a normal lipase. Another study found that the amylase could add diagnostic value to the lipase, but only if the results of the two

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Up to 20 percent of people with acute pancreatitis develop an infection outside the pancreas such as bloodstream infections, pneumonia, or urinary tract infections. These infections are associated with an increase in mortality. When an infection is suspected, antibiotics should be started while the

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The principal value of CT imaging to the treating clinician is the capacity to identify devitalised areas of the pancreas which have become necrotic due to ischaemia. Pancreatic necrosis can be reliably identified by intravenous contrast-enhanced CT imaging, and is of value if infection occurs and

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Patients with a score of zero had a mortality of less than one percent, whereas patients with a score of five had a mortality rate of 22 percent. In the validation cohort, the BISAP score had similar test performance characteristics for predicting mortality as the APACHE II score. As is a problem

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The two types of acute pancreatitis are mild and severe, which are defined based on whether the predominant response to cell injury is inflammation (mild) or necrosis (severe). In mild pancreatitis, there is inflammation and edema of the pancreas. In severe pancreatitis, there is necrosis of the

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Mostly the Ranson Criteria are used to determine severity of acute pancreatitis. In severe pancreatitis serious amounts of necrosis determine the further clinical outcome. About 20% of the acute pancreatitis are severe with a mortality of about 20%. This is an important classification as severe

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has an equal chance of causing complications and treating the underlying cause, therefore, is not recommended for treating acute pancreatitis. If a gallstone is detected, ERCP, performed within 24 to 72 hours of presentation with successful removal of the stone, is known to reduce morbidity and

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Currently, following the findings of the WATERFALL clinical trial, moderate hydration at a rate of 1.5 ml/kg per hour of isotonic crystalloid solution (e.g. normal saline or lactated Ringer's solution), preceded by one or more boluses of 10 mL/kg in case of hypovolaemia, is recommended in acute

1236:(intravenous) may be used for pain relief in acute pancreatitis. Fentanyl is being increasingly used due to its better safety profile, especially in renal impairment. As with other opiates, fentanyl can depress respiratory function. It can be given both as a bolus as well as constant infusion. 916:

and peripancreatic spaces as well as vessel damage. Necrotic fat cells appear as shadows, contours of cells, lacking the nucleus, pink, finely granular cytoplasm. It is possible to find calcium precipitates (hematoxylinophilic). Digestion of vascular walls results in thrombosis and hemorrhage.

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Triantopoulou C, Lytras D, Maniatis P, Chrysovergis D, Manes K, Siafas I, Papailiou J, Dervenis C (October 2007). "Computed tomography versus Acute Physiology and Chronic Health Evaluation II score in predicting severity of acute pancreatitis: a prospective, comparative study with statistical

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In the United States, the annual incidence is 18 cases of acute pancreatitis per 100,000 population, and it accounts for 220,000 hospitalizations in the US. In a European cross-sectional study, incidence of acute pancreatitis increased from 12.4 to 15.9 per 100,000 annually from 1985 to 1995;

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The Glasgow score is valid for both gallstone and alcohol induced pancreatitis, whereas the Ranson score is only for alcohol induced pancreatitis. If a patient scores 3 or more it indicates severe pancreatitis and the patient should be considered for transfer to ITU. It is scored through the

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Mayo-Robson's point – a point on border of inner 2/3 with the external 1/3 of the line that represents the bisection of the left upper abdominal quadrant, where tenderness on pressure exists in disease of the pancreas. At this point the tail of pancreas is projected on the abdominal

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Arvanitakis M, Koustiani G, Gantzarou A, Grollios G, Tsitouridis I, Haritandi-Kouridou A, Dimitriadis A, Arvanitakis C (May 2007). "Staging of severity and prognosis of acute pancreatitis by computed tomography and magnetic resonance imaging-a comparative study".

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Fluid requirements should be reassessed at frequent intervals in the first six hours of admission and for the next 24 to 48 hours. The rate of fluid resuscitation should be adjusted based on clinical assessment, hematocrit and blood urea nitrogen (BUN) values.

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by the presence of food in the stomach, having no food pass through the system allows the pancreas to rest. Approximately 20% of patients have a relapse of pain during acute pancreatitis. Approximately 75% of relapses occur within 48 hours of oral refeeding.

1616:, the Computed Tomography Severity Index (CTSI) is a grading system used to determine the severity of acute pancreatitis. The numerical CTSI has a maximum of ten points, and is the sum of the Balthazar grade points and pancreatic necrosis grade points: 1519:

The criteria for point assignment is that a certain breakpoint be met at any time during that 48 hour period, so that in some situations it can be calculated shortly after admission. It is applicable to both gallstone and alcoholic pancreatitis.

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Papachristou GI, Muddana V, Yadav D, O'Connell M, Sanders MK, Slivka A, Whitcomb DC (February 2010). "Comparison of BISAP, Ranson's, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis".

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Surgery is indicated for (i) infected pancreatic necrosis and (ii) diagnostic uncertainty and (iii) complications. The most common cause of death in acute pancreatitis is secondary infection. Infection is diagnosed based on 2 criteria

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to monitor and manage complications of the disease. Complications are associated with a high mortality, even with optimal management. For people with this condition, the pancreas will begin to secrete active enzymes such as

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Khalid A, Peterson M, Slivka A (August 2003). "Secretin-stimulated magnetic resonance pancreaticogram to assess pancreatic duct outflow obstruction in evaluation of idiopathic acute recurrent pancreatitis: a pilot study".

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In Western countries, the most common cause is alcohol, accounting for 65 percent of acute pancreatitis cases in the US, 20 percent of cases in Sweden, and 5 percent of those in the United Kingdom. In Eastern countries,

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Opioids are safe and effective at providing pain control in patients with acute pancreatitis. Adequate pain control requires the use of intravenous opiates, usually in the form of a patient-controlled analgesia pump.

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Mortelé KJ, Mergo PJ, Taylor HM, Wiesner W, Cantisani V, Ernst MD, Kalantari BN, Ros PR (October 2004). "Peripancreatic vascular abnormalities complicating acute pancreatitis: contrast-enhanced helical CT findings".

1423:(SIRS) and will determine the immediate clinical course. The further clinical course is then determined by bacterial infection. SIRS is the cause of bacterial (Gram negative) translocation from the patients colon. 3271:

Gardner TB, Vege SS, Chari ST, Petersen BT, Topazian MD, Clain JE, Pearson RK, Levy MJ, Sarr MG (2009). "Faster rate of initial fluid resuscitation in severe acute pancreatitis diminishes in-hospital mortality".

5649: 5634: 1743:(CRP) level. However, a few studies indicate that CTSI is not significantly associated with the prognosis of hospitalization in patients with pancreatic necrosis, nor is it an accurate predictor of AP severity. 1297:). The additional advantages of post-pyloric feeding are the inverse relationship of pancreatic exocrine secretions and distance of nutrient delivery from the pylorus, as well as reduced risk of aspiration. 3795:

Chatzicostas C, Roussomoustakaki M, Vlachonikolis IG, Notas G, Mouzas I, Samonakis D, Kouroumalis EA (November 2002). "Comparison of Ranson, APACHE II and APACHE III scoring systems in acute pancreatitis".

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however, mortality remained stable as a result of better outcomes. Another study showed a lower incidence of 9.8 per 100,000 but a similar worsening trend (increasing from 4.9 in 1963–74) over time.

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are the most common cause of acute pancreatitis. The causes of acute pancreatitis also varies across age groups, with trauma and systemic disease (such as infection) being more common in children.

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Lin XZ, Wang SS, Tsai YT, Lee SD, Shiesh SC, Pan HB, Su CH, Lin CY (February 1989). "Serum amylase, isoamylase, and lipase in the acute abdomen. Their diagnostic value for acute pancreatitis".

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While often quoted lipase levels of 3 or more times the upper-limit of normal is diagnostic of pancreatitis, there are also other differential diagnosis to be considered relating to this rise.

4279: 1047:"Although amylase is widely available and provides acceptable accuracy of diagnosis, where lipase is available it is preferred for the diagnosis of acute pancreatitis (recommendation grade A)" 1324:

Preventative antibiotics are not recommended in people with acute pancreatitis, regardless of the type (interstitial or necrotizing) or disease severity (mild, moderately severe, or severe)

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Disadvantages of a naso-enteric feeding tube include increased risk of sinusitis (especially if the tube remains in place greater than two weeks) and a still-present risk of accidentally

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Peripancreatic / extrapancreatic – irregular pancreatic outline, obliterated peripancreatic fat, retroperitoneal edema, fluid in the lessar sac, fluid in the left anterior pararenal space

148:, instead of their inactive forms. Damage to the pancreatic ducts can occur as a result of this. Damage to the liver, gallbladder, and spleen can result in severe cases of pancreatitis. 1454:

2005: "Immediate assessment should include clinical evaluation, particularly of any cardiovascular, respiratory, and renal compromise, body mass index, chest x ray, and APACHE II score"

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Acute pancreatitis occurs when there is abnormal activation of digestive enzymes within the pancreas. This occurs through inappropriate activation of inactive enzyme precursors called

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Keim V, Teich N, Fiedler F, Hartig W, Thiele G, Mössner J (January 1998). "A comparison of lipase and amylase in the diagnosis of acute pancreatitis in patients with abdominal pain".

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Jafri NS, Mahid SS, Idstein SR, Hornung CA, Galandiuk S (June 2009). "Antibiotic prophylaxis is not protective in severe acute pancreatitis: a systematic review and meta-analysis".

1023:

Reasons for false positive elevated serum amylase include salivary gland disease (elevated salivary amylase), bowel obstruction, infarction, cholecystitis, and a perforated ulcer.

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with many of the other scoring systems, the BISAP has not been validated for predicting outcomes such as length of hospital stay, need for ICU care, or need for intervention.

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Treacy J, Williams A, Bais R, Willson K, Worthley C, Reece J, Bessell J, Thomas D (October 2001). "Evaluation of amylase and lipase in the diagnosis of acute pancreatitis".

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Hastier P, Buckley MJ, Peten EP, Demuth N, Dumas R, Demarquay JF, Caroli-Bosc FX, Delmont JP (November 2000). "A new source of drug-induced acute pancreatitis: codeine".

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Vriens PW, van de Linde P, Slotema ET, Warmerdam PE, Breslau PJ (October 2005). "Computed tomography severity index is an early prognostic tool for acute pancreatitis".

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Petrov MS, van Santvoort HC, Besselink MG, Cirkel GA, Brink MA, Gooszen HG (September 2007). "Oral refeeding after onset of acute pancreatitis: a review of literature".

1989:

Rawla P, Sunkara T, Thandra KC, Gaduputi V (December 2018). "Hypertriglyceridemia-induced pancreatitis: updated review of current treatment and preventive strategies".

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Initial management of a patient with acute pancreatitis consists of supportive care with fluid resuscitation, pain control, nothing by mouth, and nutritional support.

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levels, in combination with severe abdominal pain, often trigger the initial diagnosis of acute pancreatitis. However, they have no role in assessing disease severity.

859:), where the enzyme assists in the digestion of proteins. During an episode of acute pancreatitis, trypsinogen comes into contact with lysosomal enzymes (specifically 2639:

Sternby B, O'Brien JF, Zinsmeister AR, DiMagno EP (December 1996). "What is the best biochemical test to diagnose acute pancreatitis? A prospective clinical study".

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It is also recommended that serum hematocrit be obtained at admission, 12 h after admission, and 24 h after admission to help gauge adequacy of fluid resuscitation."

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Intrapancreatic – diffuse or segmental enlargement, edema, gas bubbles, pancreatic pseudocysts and phlegmons/abscesses (which present 4 to 6 wks after initial onset)

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Testoni PA, Mariani A, Curioni S, Zanello A, Masci E (June 2008). "MRCP-secretin test-guided management of idiopathic recurrent pancreatitis: long-term outcomes".

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In the initial stages (within the first 12 to 24 hours) of acute pancreatitis, fluid replacement has been associated with a reduction in morbidity and mortality.

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Predicts mortality risk in pancreatitis with fewer variables than Ranson's criteria. Data should be taken from the first 24 hours of the patient's evaluation.

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As part of the initial injury there is an extensive inflammatory response due to pancreatic cells synthesizing and secreting inflammatory mediators: primarily

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even in intubated patients (contrary to popular belief, the endotracheal tube cuff alone is not always sufficient to prevent NG tube entry into the trachea).

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source of the infection is being determined. However, if cultures are negative and no source of infection is identified, antibiotics should be discontinued.

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Steinberg WM, Goldstein SS, Davis ND, Shamma'a J, Anderson K (May 1985). "Diagnostic assays in acute pancreatitis. A study of sensitivity and specificity".

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Abdominal CT should not be performed before the first 12 hours of onset of symptoms as early CT (<12 hours) may result in equivocal or normal findings.

4338: 921:. Due to the pancreas lacking a capsule, the inflammation and necrosis can extend to include fascial layers in the immediate vicinity of the pancreas. 120:(the term pancreatic dysfunction includes cases of acute or chronic pancreatitis where the pancreas is measurably damaged, even if it has not failed). 1739:

CTSI's staging of acute pancreatitis severity has been shown by a number of studies to provide more accurate assessment than APACHE II, Ranson, and

4842: 3927:"Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome" 2932:

Miller FH, Keppke AL, Dalal K, Ly JN, Kamler VA, Sica GT (December 2004). "MRI of pancreatitis and its complications: part 1, acute pancreatitis".

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Trikudanathan G, Navaneethan U, Vege SS (August 2012). "Current controversies in fluid resuscitation in acute pancreatitis: a systematic review".

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Smith RC, Southwell-Keely J, Chesher D (June 2005). "Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis?".

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Smith RC, Southwell-Keely J, Chesher D (June 2005). "Should serum pancreatic lipase replace serum amylase as a biomarker of acute pancreatitis?".

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In predicting the prognosis, there are several scoring indices that have been used as predictors of survival. Two such scoring systems are the

1333: 1166: 1165:) and duct anomalies. Clinical trials indicate that MRCP can be as effective a diagnostic tool for acute pancreatitis with biliary etiology as 912:). These are produced by intrapancreatic activation of pancreatic enzymes. Lipase activation produces the necrosis of fat tissue in pancreatic 592: 1020:

Serum amylase may be normal (in 10% of cases) for cases of acute or chronic pancreatitis (depleted acinar cell mass) and hypertriglyceridemia.

1157:(MRCP) sequences. MRCP provides useful information regarding the etiology of acute pancreatitis, i.e., the presence of tiny biliary stones ( 4437: 2897:

Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, Gualdi GF (October 2008). "Imaging assessment of acute pancreatitis: a review".

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Eland IA, Sturkenboom MJ, Wilson JH, Stricker BH (October 2000). "Incidence and mortality of acute pancreatitis between 1985 and 1995".

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Score 0 to 2 : 2% mortality Score 3 to 4 : 15% mortality Score 5 to 6 : 40% mortality Score 7 to 8 : 100% mortality

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Ignjatović S, Majkić-Singh N, Mitrović M, Gvozdenović M (November 2000). "Biochemical evaluation of patients with acute pancreatitis".

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The risks of ERCP are that it may worsen pancreatitis, it may introduce an infection to otherwise sterile pancreatitis, and bleeding.

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CT is an important common initial assessment tool for acute pancreatitis. Imaging is indicated during the initial presentation if:

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Besselink MG, van Santvoort HC, Boermeester MA, Nieuwenhuijs VB, van Goor H, Dejong CH, Schaapherder AF, Gooszen HG (March 2009).

4331: 1420: 3840:

Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH (February 1990). "Acute pancreatitis: value of CT in establishing prognosis".

1921: 1129:, which becomes visible), pancreatic ascites, pleural effusion (seen on basal cuts of the pleural cavity), adynamic ileus, etc. 904:

The acute pancreatitis (acute hemorrhagic pancreatic necrosis) is characterized by acute inflammation and necrosis of pancreas

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Banks PA, Freeman ML, et al. (Practice Parameters Committee of the American College of Gastroenterology) (October 2006).

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Open management – necrosectomy with planned staged reoperations at definite intervals (up to 20+ reoperations in some cases)

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In the management of acute pancreatitis, the treatment is to stop feeding the patient, giving them nothing by mouth, giving

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Abdominal pain is often the predominant symptom in patients with acute pancreatitis and should be treated with analgesics.

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of ≥ 8 Organ failure Substantial pancreatic necrosis (at least 30% glandular necrosis according to contrast-enhanced CT)

379: 307: 303: 4215:"Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality" 4917: 4324: 2811:"Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis" 2282:"Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis" 1438: 871:, which is less organized and more damaging. The balance between these two mechanisms of cellular death is mediated by 226:

Although these are common symptoms, frequently they are not all present; and epigastric pain may be the only symptom.

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Interpretation If the score ≥ 3, severe pancreatitis likely. If the score < 3, severe pancreatitis is unlikely Or

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Axial CT in a patient with acute exudative pancreatitis showing extensive fluid collections surrounding the pancreas

5334: 630: 5475: 5087: 5070: 4575: 4570: 4447: 1026:

If the lipase level is about 2.5 to 3 times that of amylase, it is an indication of pancreatitis due to alcohol.

3758: 5329: 5285: 5179: 5001: 4600: 764: 1017:

Serum lipase rises 4 to 8 hours from the onset of symptoms and normalizes within 7 to 14 days after treatment.

5540: 5386: 1426:

There are several ways to help distinguish between these two forms. One is the above-mentioned Ranson Score.

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pancreatitis will need intensive care therapy whereas mild pancreatitis can be treated on the common ward.

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be falsely reassuring as the inflammatory and necrotic process usually requires 48 hours to fully manifest.

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Moreno Escobosa MC, Amat López J, Cruz Granados S, Moya Quesada MC (2005). "Pancreatitis due to codeine".

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Larvin M, McMahon MJ (July 1989). "APACHE-II score for assessment and monitoring of acute pancreatitis".

1864: 131:(IV) nutritional support, and intravenous fluid rehydration. Severe cases often require admission to an 5744: 4875: 4804: 4405: 1603:

Serum calcium < 1.90 mmol/L (<8.0 mg/dL) or serum albumin <33 g/L (<3.2.g/dL)>

1290: 1147: 123:

Mild cases are usually successfully treated with conservative measures: hospitalization, pain control,

1469:

The Ranson score is used to predict the severity of acute pancreatitis. They were introduced in 1974.

5148: 5104: 5057: 4863: 4481: 1189: 1181: 2720: 1368:

Positive bacterial culture on FNA (fine needle aspiration, usually CT or US guided) of the pancreas.

5494: 5174: 4809: 4767: 4580: 4455: 4442: 4412: 4383: 3876: 1376:

Minimally invasive management – necrosectomy through small incision in skin (left flank) or abdomen

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Detection of common bile duct stones or dilated intrahepatic or extrahepatic ducts on abdominal CT

1192:, the finding of a hypoechoic and bulky pancreas is regarded as diagnostic of acute pancreatitis. 5419: 5196: 4937: 4729: 4388: 732: 574: 525: 3759:"APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis" 2721:"Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis" 5739: 5499: 5223: 5206: 4590: 4466: 4417: 4378: 4348: 654: 463: 275: 5693: 1944: 5431: 5350: 5339: 5300: 5228: 4531: 3877:"Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?" 994: 946: 705: 420: 296: 279: 238: 3315:

Basurto Ona X, Rigau Comas D, Urrútia G (July 2013). "Opioids for acute pancreatitis pain".

5470: 5414: 5235: 5131: 4714: 4709: 4543: 4461: 4427: 1842: 1063: 942: 934: 738: 582: 425: 351: 210: 113: 2086:"Clinical implications and risk factors of acute pancreatitis after cardiac valve surgery" 1312:

Oxygen may be provided in some patients (about 30%) if Pao2 levels fall below 70mm of Hg.

36: 8: 5653: 5564: 5374: 5267: 5250: 5211: 5184: 5136: 4979: 4956: 4949: 4898: 4870: 4792: 4787: 4782: 4699: 4316: 4309: 1837: 1301: 1158: 1143: 1072: 755: 430: 415: 199: 132: 3350:

Helm JF, Venu RP, Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Arndorfer RC (October 1988).

2762:"Significant elevations of serum lipase not caused by pancreatitis: a systematic review" 1177: 5576: 5441: 5424: 5396: 5379: 5245: 4880: 4772: 4744: 4678: 4504: 4400: 4365: 4296: 4195: 4117: 4037: 3953: 3926: 3907: 3821: 3739: 3616: 3589: 3530: 3505: 3486: 3437: 3376: 3351: 3297: 3253: 3210: 3028: 2835: 2810: 2786: 2761: 2701: 2627: 2587: 2492: 2455: 2404: 2379: 2357: 2253: 2201: 2158: 2126: 2110: 2085: 2061: 2036: 2014: 1881: 1740: 1278: 1126: 1085:

there is abdominal distension and tenderness, fever >102 F (38,9 C), or leukocytosis

769: 260:

Körte's sign (pain or resistance in the zone where the head of pancreas is located (in

117: 5658: 4271: 4239: 4214: 3989: 3727: 1105:

to determine therapeutic response after surgery or interventional radiologic procedure

5664: 5554: 5535: 4908: 4301: 4244: 4199: 4187: 4152: 4109: 4073: 4029: 3993: 3958: 3899: 3857: 3813: 3809: 3770: 3731: 3694: 3669: 3644: 3621: 3570: 3535: 3478: 3429: 3415: 3381: 3332: 3289: 3245: 3202: 3161: 3110: 3069: 3020: 2984: 2949: 2914: 2876: 2840: 2791: 2742: 2693: 2689: 2656: 2619: 2579: 2575: 2550: 2546: 2521: 2484: 2480: 2447: 2443: 2409: 2349: 2344: 2327: 2303: 2298: 2281: 2245: 2193: 2150: 2146: 2115: 2066: 2006: 1950: 1245: 815: 696: 323: 52: 4121: 4041: 3911: 3853: 3825: 3743: 3441: 3214: 2705: 2631: 2591: 2496: 2459: 2257: 2205: 2162: 2084:

Chung JW, Ryu SH, Jo JH, Park JY, Lee S, Park SW, Song SY, Chung JB (January 2013).

2018: 5704: 5601: 5521: 5516: 5506: 5368: 5240: 5168: 4986: 4893: 4888: 4818: 4777: 4585: 4550: 4291: 4234: 4226: 4179: 4144: 4101: 4065: 4021: 3985: 3948: 3938: 3891: 3849: 3805: 3723: 3611: 3601: 3562: 3525: 3517: 3490: 3468: 3419: 3411: 3371: 3363: 3328: 3324: 3301: 3281: 3257: 3237: 3192: 3151: 3141: 3127: 3100: 3089:"American College of Gastroenterology Guidelines: Management of Acute Pancreatitis" 3059: 3032: 3012: 2976: 2941: 2906: 2868: 2830: 2822: 2781: 2773: 2732: 2685: 2648: 2611: 2571: 2542: 2513: 2476: 2439: 2399: 2391: 2361: 2339: 2293: 2235: 2185: 2142: 2105: 2097: 2056: 2048: 1998: 1873: 930: 876:

chronic ethanol exposure or through a severe insult then necrosis can predominate.

806: 788: 722: 682: 608: 558: 371: 244: 179: 145: 124: 97: 85: 57: 3566: 3105: 3088: 2737: 2224:"American College of Gastroenterology guideline: management of acute pancreatitis" 2175: 5559: 5489: 5355: 5290: 5255: 5126: 4991: 4927: 4829: 4748: 4739: 4689: 4629: 4514: 4491: 4025: 3521: 3241: 1828:

is a more common cause in adolescents and young adults than in other age groups.

1531: 1464: 1430: 801: 700: 692: 268: 163: 89: 61: 5707: 4069: 2517: 1169:, but with the benefits of being less invasive and causing fewer complications. 5596: 5511: 5065: 5038: 4903: 4838: 4834: 4724: 4694: 2945: 2910: 1162: 750: 718: 666: 479: 394: 274:

Mayo-Robson's sign (pain while pressing at the top of the angle lateral to the

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Two or more fluid collections and / or gas bubbles in or adjacent to pancreas

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Alternatively, pancreatitis can be diagnosed by meeting any of the following:

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BUN increased by 1.8 or more mmol/L (5 or more mg/dL) after IV fluid hydration

1146:

is considered the gold standard in diagnostic imaging for acute pancreatitis,

257:, large bruise, around the umbilicus due to local toxic lesion of the vessels) 5723: 5529: 5482: 5275: 5218: 5201: 5113: 4858: 4685: 4560: 4526: 4471: 3943: 3925:

Leung TK, Lee CM, Lin SY, Chen HC, Wang HJ, Shen LK, Chen YY (October 2005).

3606: 3454: 1273:

The incidence of relapse after oral refeeding may be reduced by post-pyloric

1229: 1115:

CT findings can be classified into the following categories for easy recall:

978: 972: 893: 796: 578: 347: 331: 319: 5643: 4183: 3506:"The impact of hospital-acquired infection on outcome in acute pancreatitis" 3130:"IAP/APA evidence-based guidelines for the management of acute pancreatitis" 2395: 1382:

Closed management – necrosectomy with closed continuous postoperative lavage

1098:

CT is recommended as a delayed assessment tool in the following situations:

5404: 5316: 5189: 5092: 5043: 5028: 5023: 5019: 4932: 4757: 4673: 4565: 4555: 4521: 4305: 4248: 4191: 4156: 4113: 4077: 4033: 3997: 3962: 3903: 3817: 3774: 3625: 3574: 3539: 3482: 3433: 3367: 3336: 3293: 3249: 3206: 3165: 3156: 3114: 3073: 3024: 2988: 2953: 2918: 2880: 2795: 2697: 2623: 2488: 2451: 2413: 2353: 2249: 2197: 2154: 2119: 2070: 2010: 967: 913: 774: 727: 662: 650: 634: 586: 513: 343: 315: 195: 141: 73: 45: 3861: 3735: 3385: 3064: 3047: 2844: 2746: 2660: 2615: 2583: 2554: 2525: 2307: 5688: 5584: 5346: 5324: 5155: 5075: 4719: 4620: 4373: 4148: 4105: 3778: 2601: 2240: 2223: 1577: 1573: 1406: 1262: 1258: 918: 848: 674: 670: 646: 642: 638: 411: 406: 375: 367: 261: 215: 204: 128: 93: 4266: 3875:

Knoepfli AS, Kinkel K, Berney T, Morel P, Becker CD, Poletti PA (2007).

1265:, and sufficient pain control. As the pancreas is stimulated to secrete 5360: 5033: 5011: 4656: 4595: 4010: 2652: 1885: 1598: 1399: 1237: 909: 905: 626: 254: 5626: 3424: 3285: 2777: 2377: 1924:. The National Institute of Diabetes and Digestive and Kidney Diseases 1091:

there is no improvement after 72 hours of conservative medical therapy

5699: 5310: 5280: 5143: 5121: 4974: 4825: 4799: 4661: 4651: 4538: 4499: 4432: 4090: 3473: 3456: 2857: 2189: 2030: 2028: 1821: 1555: 1549: 1434: 983: 889: 864: 860: 784: 779: 658: 622: 618: 604: 490: 475: 363: 327: 81: 2638: 2052: 1877: 4944: 4922: 4634: 2503: 1590: 1294: 1241: 1233: 1038:

Regarding selection on these tests, two practice guidelines state:

988: 872: 868: 856: 844: 832: 760: 678: 485: 458: 174: 77: 3975: 3401: 3048:"Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis" 2025: 1365:

Gas bubbles on CT scan (present in 20 to 50% of infected necrosis)

4996: 4762: 4666: 4638: 4135:

Whitcomb DC (May 2006). "Clinical practice. Acute pancreatitis".

1565: 1500:

Calcium (serum calcium < 2.0 mmol/L (< 8.0 mg/dL)

1332:

In 30% of those with acute pancreatitis, no cause is identified.

1327: 1289:

Recently, there has been a shift in the management paradigm from

1274: 1007: 852: 827: 810: 711: 564: 137: 109: 908:, focal enzymic necrosis of pancreatic fat and vessel necrosis ( 5638: 5462: 5080: 4966: 1661:

Pancreatic gland abnormalities and peripancreatic inflammation

1266: 1094:

there has been an acute change in status: fever, pain, or shock

1011: 612: 503: 220: 189: 169: 101: 4169: 3839: 2896: 1969: 4912: 4642: 3666:

Current Obstetric & Gynecologic Diagnosis & Treatment

3314: 1825: 688: 184: 105: 3227: 3128:

Working Group IAP/APA Acute Pancreatitis Guidelines (2013).

2966: 1345:

Clinical deterioration or lack of improvement after 24 hours

1125:

Locoregional – Gerota's fascia sign (thickening of inflamed

250:

Pleural effusions (fluid in the bases of the pleural cavity)

166:(upper abdominal pain) radiating to the back in 50% of cases 2675: 2429: 2280:

Gumaste VV, Dave PB, Weissman D, Messer J (November 1991).

2169: 1988: 1379:

Conventional management – necrosectomy with simple drainage

1108:

before discharge in patients with severe acute pancreatitis

1052:

tests were combined with a discriminant function equation.

4346: 1796:

Evidence of SIRS (systemic inflammatory response syndrome)

1244:

because of the belief that morphine caused an increase in

557:

Biliary pancreatitis due to gallstones or constriction of

4054: 3874: 3688: 2719:

Corsetti JP, Cox C, Schulz TJ, Arvan DA (December 1993).

2466: 2279: 2222:

Tenner S, Baillie J, DeWitt J, Vege SS (September 2013).

2132: 1594: 1484:

blood glucose > 11.1 mmol/L (> 200 mg/dL)

949:, liver function, serum calcium, serum amylase and lipase 851:. Normally, trypsinogen is converted to its active form ( 3552: 3504:

Wu BU, Johannes RS, Kurtz S, Banks PA (September 2008).

3270: 2380:"UK guidelines for the management of acute pancreatitis" 3457:"Timing and impact of infections in acute pancreatitis" 2221: 1976:

Surgical Treatment: Evidence-Based and Problem-Oriented

1793:

Abnormal mental status with a Glasgow coma score <15

1281:

prior to oral refeeding. IMRIE scoring is also useful.

2718: 2561: 2217: 2215: 2034: 1407:

Classification by severity: prognostic scoring systems

445:

Gastric varices (secondary to splenic vein thrombosis)

108:. Acute pancreatitis may be a single event; it may be 3830:(comment=this study used an Apache cutoff of >=10) 3763:

Hepatobiliary & Pancreatic Diseases International

2808: 2037:"Review of Infectious Etiology of Acute Pancreatitis" 1970:

Bassi C, Falconi M, Butturini G, Pederzoli P (2001).

1862:

Sommermeyer L (December 1935). "Acute Pancreatitis".

1088:

there is a Ranson score > 3 or APACHE score > 8

5616: 3689:

Peitzman AB, Schwab CW, Yealy DM, Fabian TC (2007).

3638: 3503: 3352:"Effects of morphine on the human sphincter of Oddi" 3178: 3001: 1558:) score > 8 points predicts 11% to 18% mortality 1395:

Pancreatic enzyme inhibitors are proven not to work.

4280:"Cullen's sign for acute haemorrhagic pancreatitis" 3349: 2931: 2598:Without support for the superiority of the lipase: 2378:UK Working Party on Acute Pancreatitis (May 2005). 2212: 1134:surgical or percutaneous debridement is indicated. 3045: 1972:"Early complications of severe acute pancreatitis" 1612:Developed in the early 1990s by Emil J. Balthazar 1554:"Acute Physiology And Chronic Health Evaluation" ( 847:(or proenzymes) inside the pancreas, most notably 442:Gastrointestinal hemorrhage from stress ulceration 234:The following are associated with severe disease: 5721: 3691:The Trauma Manual: Trauma and Acute Care Surgery 2035:Rawla P, Bandaru SS, Vellipuram AR (June 2017). 1512:Base deficit (negative base excess) > 4 mEq/L 1372:Surgical options for infected necrosis include: 1082:the diagnosis of acute pancreatitis is uncertain 885:pancreas, and nearby organs may become injured. 4212: 3924: 3790: 3788: 3663: 3397: 3395: 3181:"Early management of severe acute pancreatitis" 2892: 2890: 2809:Larvin M, Chalmers AG, McMahon MJ (June 1990). 2759: 2373: 2371: 2321: 2319: 2317: 1341:mortality. The indications for early ERCP are: 1153:Another advantage of MRI is its utilization of 267:Kamenchik's sign (pain with pressure under the 4277: 4265:Banks et al. Modified Marshall scoring system 2760:Hameed AM, Lam VW, Pleass HC (February 2015). 2532: 2083: 1334:Endoscopic retrograde cholangiopancreatography 1328:Endoscopic retrograde cholangiopancreatography 1167:endoscopic retrograde cholangiopancreatography 4332: 3713: 2426:In support of the superiority of the lipase: 1942: 1771:E – Enzymes: LDH >600iu/L; AST >200iu/L 1650:Focal or diffuse enlargement of the pancreas 1137: 4438:Esophagogastric junction outflow obstruction 4048: 4004: 3969: 3918: 3868: 3785: 3750: 3587: 3392: 3086: 2995: 2960: 2925: 2887: 2851: 2669: 2368: 2325: 2314: 855:) in the first part of the small intestine ( 247:(hemorrhagic discoloration of the umbilicus) 80:. Causes, in order of frequency, include: a 3978:Journal of the American College of Surgeons 3833: 3756: 3317:The Cochrane Database of Systematic Reviews 2802: 2712: 2328:"Practice guidelines in acute pancreatitis" 2273: 1861: 1777:S – Sugar: blood glucose >10 mmol/L 1768:R – Renal function: Urea >16 mmol/L 1526: 1481:white blood cell count > 16000 cells/mm3 1155:magnetic resonance cholangiopancreatography 867:, which is physiologically controlled, and 4477:Esophageal intramural pseudodiverticulosis 4339: 4325: 3707: 2604:Clinical Chemistry and Laboratory Medicine 1855: 35: 4295: 4238: 3952: 3942: 3615: 3605: 3529: 3472: 3423: 3375: 3196: 3179:Talukdar R, Swaroop Vege S (April 2011). 3155: 3145: 3104: 3063: 2834: 2785: 2736: 2403: 2343: 2297: 2239: 2109: 2060: 957: 493:(angiopathic retinopathy with hemorrhage) 241:(hemorrhagic discoloration of the flanks) 44:Still from 3D medical animation of acute 4278:Parikh, RP; Upadhyay, KJ (Jul 4, 2013). 4172:Scandinavian Journal of Gastroenterology 4134: 4094:The American Journal of Gastroenterology 3404:The American Journal of Gastroenterology 2332:The American Journal of Gastroenterology 2228:The American Journal of Gastroenterology 2135:The American Journal of Gastroenterology 1176: 1062: 826: 1974:. In Holzheimer RG, Mannick JA (eds.). 1922:"Symptoms & Causes of Pancreatitis" 1790:BUN >25 mg/dL (8.9 mmol/L) 1421:systemic inflammatory response syndrome 1402:has been shown not to improve outcomes. 5722: 3588:Canlas KR, Branch MS (December 2007). 2934:AJR. American Journal of Roentgenology 1802:Imaging study reveals pleural effusion 1672:Fluid collection in a single location 1284: 1058: 929:Acute pancreatitis is diagnosed using 509:Disseminated intravascular coagulation 312:disseminated intravascular coagulation 5461: 4705:Small intestinal bacterial overgrowth 4320: 4213:Goldacre MJ, Roberts SE (June 2004). 3757:Yeung YP, Lam BY, Yip AW (May 2006). 3693:. Lippincott Williams & Wilkins. 3639:Apostolakos MJ, Papadakos PJ (2001). 962:The differential diagnosis includes: 151: 2535:Journal of Clinical Gastroenterology 1991:Clinical Journal of Gastroenterology 1762:N – Neutrophilia: WCC >15x10(9)/L 1203: 4137:The New England Journal of Medicine 1506:Oxygen (hypoxemia PO2 < 60 mmHg) 1240:has been historically favored over 917:Inflammatory infiltrate is rich in 595:retrograde cholangiopancreatography 380:acute respiratory distress syndrome 326:(from pancreatic insulin-producing 324:insulin dependent diabetes mellitus 308:multiple organ dysfunction syndrome 304:acute respiratory distress syndrome 295:Locoregional complications include 264:, 6–7 cm above the umbilicus)) 13: 2899:Seminars in Ultrasound, CT and MRI 1607: 1543: 879: 278:and below the left 12th rib (left 14: 5756: 5590:Spontaneous bacterial peritonitis 5437:Exocrine pancreatic insufficiency 4259: 3990:10.1016/j.jamcollsurg.2005.06.269 3931:World Journal of Gastroenterology 3594:World Journal of Gastroenterology 1949:. JP Medical Ltd. pp. 488–. 1946:SRB's Clinical Methods in Surgery 1389: 899: 526:Painful subcutaneous fat necrosis 5335:Secondary sclerosing cholangitis 3810:10.1097/00006676-200211000-00002 3416:10.1111/j.1572-0241.2007.01357.x 3185:Current Gastroenterology Reports 2690:10.1111/j.1445-2197.2005.03391.x 2576:10.1097/00006676-199801000-00008 2547:10.1097/00004836-198902000-00011 2481:10.1046/j.1445-2197.2001.02220.x 2444:10.1111/j.1445-2197.2005.03391.x 2345:10.1111/j.1572-0241.2006.00856.x 2178:Allergologia et Immunopathologia 2147:10.1111/j.1572-0241.2000.03213.x 1746: 1515:Sequestration of fluids > 6 L 290: 4576:Gastric antral vascular ectasia 4571:Portal hypertensive gastropathy 4448:Gastroesophageal reflux disease 4206: 4163: 4128: 4084: 3854:10.1148/radiology.174.2.2296641 3682: 3664:DeCherney AH, Lauren N (2003). 3657: 3632: 3581: 3546: 3497: 3448: 3343: 3308: 3264: 3221: 3172: 3121: 3080: 3039: 3005:Digestive Diseases and Sciences 2753: 2420: 2264: 1810: 1472: 1458: 1419:Necrosis will be followed by a 1219: 838: 391:Renal artery or vein thrombosis 302:Systemic complications include 5330:Primary sclerosing cholangitis 5180:Hepatic veno-occlusive disease 5002:Solitary rectal ulcer syndrome 3461:The British Journal of Surgery 3329:10.1002/14651858.CD009179.pub2 2077: 1982: 1963: 1936: 1914: 1892: 1781: 1494: 1315: 1000: 744: 551: 482:(confusion, delusion and coma) 1: 5387:Sphincter of Oddi dysfunction 4058:European Journal of Radiology 3728:10.1016/S0140-6736(89)90381-4 3567:10.1016/j.amjsurg.2008.08.016 3106:10.14309/ajg.0000000000002645 2270:Bailey & Love's/24th/1123 1848: 1774:A – Albumin <32g/L (serum) 1765:C – Calcium <2 mmol/L 1252: 1172: 1075:, practice guidelines state: 570:Idiopathic in 15–25% of cases 253:Grünwald sign (appearance of 5296:Postcholecystectomy syndrome 4815:Intestinal pseudoobstruction 4423:Esophageal motility disorder 4026:10.1097/MPA.0b013e3180619662 3668:. McGraw-Hill Professional. 3643:. McGraw-Hill Professional. 3522:10.1053/j.gastro.2008.05.053 3242:10.1097/MPA.0b013e31824c1598 2299:10.1016/0016-5085(91)90089-4 1943:Sriram Bhat M (2018-10-31). 1799:Patient age >60 years old 1593:(<50 mL/h) or increasing 1562:Hemorrhagic peritoneal fluid 1195: 924: 822: 787:other than mumps, including 448:Gastrointestinal obstruction 7: 4070:10.1016/j.ejrad.2003.10.006 3555:American Journal of Surgery 3046:Enrique de-Madaria (2022). 2861:Digestive and Liver Disease 2738:10.1093/clinchem/39.12.2495 2518:10.7326/0003-4819-102-5-576 2506:Annals of Internal Medicine 1865:American Journal of Nursing 1831: 1570:Indicators of organ failure 1444:Practice guidelines state: 318:(from fat saponification), 229: 88:beyond the point where the 10: 5761: 5281:Gallstone / Cholelithiasis 4805:Functional colonic disease 4601:Zollinger–Ellison syndrome 2969:Gastrointestinal Endoscopy 2946:10.2214/ajr.183.6.01831637 2911:10.1053/j.sult.2008.06.009 1547: 1478:age in years > 55 years 1462: 1355: 1291:total parenteral nutrition 1148:magnetic resonance imaging 1138:Magnetic resonance imaging 717:Structural abnormalities: 5679: 5620: 5575: 5454: 5395: 5309: 5266: 5112: 5103: 5056: 5010: 4965: 4851: 4738: 4628: 4615: 4490: 4482:Acute esophageal necrosis 4364: 4355: 4231:10.1136/bmj.328.7454.1466 3896:10.1007/s00261-006-9034-y 3641:The Intensive Care Manual 3410:(9): 2079–84, quiz 2085. 3198:10.1007/s11894-010-0174-4 3147:10.1016/j.pan.2013.07.063 2981:10.1016/j.gie.2007.09.007 2873:10.1016/j.dld.2007.01.015 2827:10.1136/bmj.300.6737.1425 2102:10.3349/ymj.2013.54.1.154 2041:Gastroenterology Research 2003:10.1007/s12328-018-0881-1 1307: 1190:abdominal ultrasonography 1182:Abdominal ultrasonography 546: 537:Subcutaneous fat necrosis 156: 51: 43: 34: 30:Acute pancreatic necrosis 26: 21: 4581:Gastric dumping syndrome 4456:Laryngopharyngeal reflux 4443:Diffuse esophageal spasm 3944:10.3748/wjg.v11.i38.6049 3607:10.3748/wjg.v13.i47.6314 1759:A – Age >55-years-old 1527:Alternative Ranson score 334:due to exocrine failure 112:; or it may progress to 5197:Alcoholic liver disease 4730:Bile acid malabsorption 4674:Peptic (duodenal) ulcer 4184:10.1080/003655200451261 4100:(2): 435–41, quiz 442. 3017:10.1023/A:1024747319606 2641:Mayo Clinic Proceedings 2396:10.1136/gut.2004.057026 1978:. Munich: Zuckschwerdt. 1503:Hematocrit fall >10% 1490:serum LDH > 350 IU/L 1487:serum AST > 250 IU/L 1071:Regarding the need for 1029:Decreased serum calcium 941:Blood investigations – 733:Autoimmune pancreatitis 575:hereditary pancreatitis 198:instability, including 5207:Hepatic encephalopathy 4591:Buried bumper syndrome 4522:Peptic (gastric) ulcer 4406:Mallory–Weiss syndrome 4349:human digestive system 3368:10.1136/gut.29.10.1402 2678:ANZ Journal of Surgery 2469:ANZ Journal of Surgery 2432:ANZ Journal of Surgery 2090:Yonsei Medical Journal 1338:biliary sphincterotomy 1336:(ERCP) with empirical 1302:intubating the trachea 1185: 1102:acute change in status 1068: 958:Differential diagnosis 835: 583:elevated triglycerides 464:Portal vein thrombosis 276:erector spinae muscles 5432:Pancreatic pseudocyst 5301:Porcelain gallbladder 4413:Zenker's diverticulum 3087:Scott Tenner (2024). 3065:10.1056/NEJMoa2202884 2616:10.1515/CCLM.2000.173 1576:(SBP <90 mmHG) or 1412:severe pancreatitis. 1184:of acute pancreatitis 1180: 1066: 995:Myocardial infarction 947:kidney function tests 830: 706:Mycoplasma pneumoniae 573:Metabolic disorders: 421:Myocardial infarction 297:pancreatic pseudocyst 5236:Hepatorenal syndrome 5175:Budd–Chiari syndrome 5132:Autoimmune hepatitis 4957:Intestinal adhesions 4715:Short bowel syndrome 4544:Functional dyspepsia 4462:Esophageal stricture 4428:Nutcracker esophagus 4149:10.1056/NEJMcp054958 4106:10.1038/ajg.2009.622 3140:(4 Suppl 2): e1–15. 2241:10.1038/ajg.2013.218 2234:(9): 1400–15, 1416. 1843:Chronic pancreatitis 1752:mnemonic, PANCREAS: 943:complete blood count 935:physical examination 739:hypertriglyceridemia 426:Pericardial effusion 352:hypertriglyceridemia 280:costovertebral angle 211:respiratory distress 114:chronic pancreatitis 104:; and, in children, 5730:Medical emergencies 5375:Choledocholithiasis 5246:Metabolic disorders 5212:Acute liver failure 5185:Portal hypertension 5137:Alcoholic hepatitis 4980:Radiation proctitis 4899:Mesenteric ischemia 4871:Gastroenterocolitis 4700:Blind loop syndrome 4510:Ménétrier's disease 4418:Barrett's esophagus 2390:(Suppl 3): iii1–9. 1838:Canine pancreatitis 1722:30 to 50% necrosis 1698:Necrosis percentage 1285:Nutritional support 1159:choledocholithiasis 1144:computed tomography 1073:computed tomography 1059:Computed tomography 793:Hyperparathyroidism 770:Heart valve surgery 756:Chinese liver fluke 431:Vascular thrombosis 133:intensive care unit 5735:Pancreas disorders 5680:External resources 5550:Undefined location 5541:Grynfeltt–Lesshaft 5442:Pancreatic fistula 5425:Pancreatic abscess 5380:Biliary dyskinesia 5351:Mirizzi's syndrome 4852:Large and/or small 4532:Dieulafoy's lesion 4401:Boerhaave syndrome 3093:Am J Gastroenterol 2725:Clinical Chemistry 2653:10.4065/71.12.1138 1741:C-reactive protein 1730:Over 50% necrosis 1714:0 to 30% necrosis 1279:parenteral feeding 1261:fluids to prevent 1186: 1069: 836: 601:Penetrating ulcers 239:Grey-Turner's sign 152:Signs and symptoms 118:pancreatic failure 70:Acute pancreatitis 22:Acute pancreatitis 5745:Medical mnemonics 5717: 5716: 5614: 5613: 5610: 5609: 5450: 5449: 5052: 5051: 4909:Bowel obstruction 4611: 4610: 4267:online calculator 3884:Abdominal Imaging 3700:978-0-7817-6275-5 3675:978-0-8385-1401-6 3650:978-0-07-006696-0 3286:10.1159/000210022 2778:10.1111/hpb.12277 1956:978-93-5270-545-0 1872:(12): 1157–1161. 1756:P – PaO2 <8kPa 1737: 1736: 1690: 1689: 1628:Appearance on CT 1580:> 130 beat/min 1246:sphincter of Oddi 1204:Fluid replacement 816:Codeine phosphate 697:coxsackie B virus 486:Cerebral Embolism 207:(rapid heartbeat) 72:(AP) is a sudden 67: 66: 16:Medical condition 5752: 5618: 5617: 5602:Pneumoperitoneum 5459: 5458: 5369:Common bile duct 5251:Wilson's disease 5241:Peliosis hepatis 5110: 5109: 4987:Proctalgia fugax 4894:Abdominal angina 4819:Ogilvie syndrome 4768:Pseudomembranous 4626: 4625: 4586:Gastric volvulus 4551:Pyloric stenosis 4362: 4361: 4347:Diseases of the 4341: 4334: 4327: 4318: 4317: 4313: 4312:on Dec 23, 2017. 4308:. Archived from 4299: 4284:Indian J Med Res 4253: 4252: 4242: 4225:(7454): 1466–9. 4210: 4204: 4203: 4167: 4161: 4160: 4132: 4126: 4125: 4088: 4082: 4081: 4052: 4046: 4045: 4008: 4002: 4001: 3973: 3967: 3966: 3956: 3946: 3922: 3916: 3915: 3881: 3872: 3866: 3865: 3837: 3831: 3829: 3792: 3783: 3782: 3777:. Archived from 3754: 3748: 3747: 3711: 3705: 3704: 3686: 3680: 3679: 3661: 3655: 3654: 3636: 3630: 3629: 3619: 3609: 3585: 3579: 3578: 3550: 3544: 3543: 3533: 3510:Gastroenterology 3501: 3495: 3494: 3476: 3474:10.1002/bjs.6447 3452: 3446: 3445: 3427: 3399: 3390: 3389: 3379: 3347: 3341: 3340: 3312: 3306: 3305: 3268: 3262: 3261: 3225: 3219: 3218: 3200: 3176: 3170: 3169: 3159: 3149: 3125: 3119: 3118: 3108: 3084: 3078: 3077: 3067: 3058:(11): 989–1000. 3043: 3037: 3036: 2999: 2993: 2992: 2964: 2958: 2957: 2929: 2923: 2922: 2894: 2885: 2884: 2855: 2849: 2848: 2838: 2821:(6737): 1425–8. 2806: 2800: 2799: 2789: 2757: 2751: 2750: 2740: 2716: 2710: 2709: 2673: 2667: 2664: 2635: 2595: 2558: 2529: 2500: 2463: 2424: 2418: 2417: 2407: 2375: 2366: 2365: 2347: 2338:(10): 2379–400. 2323: 2312: 2311: 2301: 2286:Gastroenterology 2277: 2271: 2268: 2262: 2261: 2243: 2219: 2210: 2209: 2190:10.1157/13075703 2173: 2167: 2166: 2130: 2124: 2123: 2113: 2081: 2075: 2074: 2064: 2032: 2023: 2022: 1986: 1980: 1979: 1967: 1961: 1960: 1940: 1934: 1933: 1931: 1929: 1918: 1912: 1911: 1909: 1907: 1896: 1890: 1889: 1859: 1695: 1694: 1631:CT grade points 1625:Balthazar grade 1622: 1621: 1619:Balthazar grade 931:clinical history 789:varicella zoster 723:pancreas divisum 683:sodium valproate 609:head of pancreas 598:Abdominal trauma 559:ampulla of Vater 438:Gastrointestinal 180:loss of appetite 146:carboxypeptidase 125:nothing by mouth 98:systemic disease 92:joins it; heavy 86:common bile duct 84:impacted in the 58:Gastroenterology 39: 19: 18: 5760: 5759: 5755: 5754: 5753: 5751: 5750: 5749: 5720: 5719: 5718: 5713: 5712: 5675: 5674: 5629: 5615: 5606: 5571: 5560:Internal hernia 5446: 5391: 5356:Biliary fistula 5314: 5305: 5291:Adenomyomatosis 5286:Cholesterolosis 5262: 5256:Hemochromatosis 5127:Viral hepatitis 5099: 5048: 5006: 4992:Rectal prolapse 4961: 4928:Fecal impaction 4918:Intussusception 4881:Crohn's disease 4847: 4830:Toxic megacolon 4742: 4740:Large intestine 4734: 4679:Curling's ulcer 4632: 4630:Small intestine 4619: 4607: 4515:Gastroenteritis 4486: 4351: 4345: 4272:Pathology Atlas 4262: 4257: 4256: 4211: 4207: 4168: 4164: 4143:(20): 2142–50. 4133: 4129: 4089: 4085: 4053: 4049: 4009: 4005: 3974: 3970: 3937:(38): 6049–52. 3923: 3919: 3879: 3873: 3869: 3838: 3834: 3793: 3786: 3755: 3751: 3722:(8656): 201–5. 3712: 3708: 3701: 3687: 3683: 3676: 3662: 3658: 3651: 3637: 3633: 3600:(47): 6314–20. 3586: 3582: 3551: 3547: 3502: 3498: 3453: 3449: 3400: 3393: 3348: 3344: 3323:(7): CD009179. 3313: 3309: 3269: 3265: 3226: 3222: 3177: 3173: 3157:1854/LU-8582111 3126: 3122: 3085: 3081: 3044: 3040: 3000: 2996: 2965: 2961: 2930: 2926: 2895: 2888: 2856: 2852: 2807: 2803: 2758: 2754: 2717: 2713: 2674: 2670: 2647:(12): 1138–44. 2425: 2421: 2376: 2369: 2324: 2315: 2278: 2274: 2269: 2265: 2220: 2213: 2174: 2170: 2131: 2127: 2082: 2078: 2053:10.14740/gr858w 2033: 2026: 1987: 1983: 1968: 1964: 1957: 1941: 1937: 1927: 1925: 1920: 1919: 1915: 1905: 1903: 1898: 1897: 1893: 1878:10.2307/3412015 1860: 1856: 1851: 1834: 1813: 1784: 1749: 1692:Necrosis score 1610: 1608:Balthazar score 1586: 1552: 1546: 1544:APACHE II score 1529: 1497: 1475: 1467: 1465:Ranson criteria 1461: 1431:Ranson criteria 1409: 1392: 1358: 1330: 1318: 1310: 1287: 1255: 1222: 1209:pancreatitis. 1206: 1198: 1175: 1140: 1127:Gerota's fascia 1061: 1006:Elevated serum 1003: 960: 927: 902: 882: 880:Pathophysiology 841: 831:Anatomy of the 825: 802:Cystic fibrosis 747: 701:cytomegalovirus 693:viral hepatitis 567:in 30% of cases 561:in 40% of cases 554: 549: 293: 269:xiphoid process 232: 164:epigastric pain 159: 154: 90:pancreatic duct 62:general surgery 17: 12: 11: 5: 5758: 5748: 5747: 5742: 5737: 5732: 5715: 5714: 5711: 5710: 5696: 5684: 5683: 5681: 5677: 5676: 5673: 5672: 5661: 5646: 5630: 5625: 5624: 5622: 5621:Classification 5612: 5611: 5608: 5607: 5605: 5604: 5599: 5597:Hemoperitoneum 5594: 5593: 5592: 5581: 5579: 5573: 5572: 5570: 5569: 5568: 5567: 5562: 5557: 5546: 5545: 5544: 5543: 5538: 5525: 5524: 5519: 5514: 5509: 5504: 5503: 5502: 5497: 5486: 5485: 5480: 5479: 5478: 5467: 5465: 5456: 5452: 5451: 5448: 5447: 5445: 5444: 5439: 5434: 5429: 5428: 5427: 5422: 5417: 5412: 5401: 5399: 5393: 5392: 5390: 5389: 5384: 5383: 5382: 5377: 5364: 5363: 5358: 5353: 5344: 5343: 5342: 5337: 5332: 5321: 5319: 5307: 5306: 5304: 5303: 5298: 5293: 5288: 5283: 5278: 5272: 5270: 5264: 5263: 5261: 5260: 5259: 5258: 5253: 5243: 5238: 5233: 5232: 5231: 5226: 5216: 5215: 5214: 5209: 5199: 5194: 5193: 5192: 5187: 5182: 5177: 5165: 5164: 5163: 5153: 5152: 5151: 5141: 5140: 5139: 5134: 5129: 5118: 5116: 5107: 5101: 5100: 5098: 5097: 5096: 5095: 5085: 5084: 5083: 5078: 5068: 5066:Blood in stool 5062: 5060: 5054: 5053: 5050: 5049: 5047: 5046: 5041: 5039:Anal dysplasia 5036: 5031: 5026: 5016: 5014: 5008: 5007: 5005: 5004: 4999: 4994: 4989: 4984: 4983: 4982: 4971: 4969: 4963: 4962: 4960: 4959: 4954: 4953: 4952: 4942: 4941: 4940: 4930: 4925: 4920: 4915: 4906: 4904:Angiodysplasia 4901: 4896: 4885: 4884: 4883: 4873: 4868: 4867: 4866: 4855: 4853: 4849: 4848: 4846: 4845: 4839:Diverticulosis 4835:Diverticulitis 4832: 4823: 4822: 4821: 4812: 4802: 4797: 4796: 4795: 4790: 4785: 4780: 4775: 4770: 4760: 4754: 4752: 4736: 4735: 4733: 4732: 4727: 4725:Milroy disease 4722: 4717: 4712: 4707: 4702: 4697: 4695:Tropical sprue 4692: 4683: 4682: 4681: 4671: 4670: 4669: 4664: 4659: 4648: 4646: 4623: 4617:Lower GI tract 4613: 4612: 4609: 4608: 4606: 4605: 4604: 4603: 4593: 4588: 4583: 4578: 4573: 4568: 4563: 4558: 4553: 4548: 4547: 4546: 4536: 4535: 4534: 4529: 4519: 4518: 4517: 4512: 4507: 4496: 4494: 4488: 4487: 4485: 4484: 4479: 4474: 4469: 4464: 4459: 4453: 4452: 4451: 4445: 4440: 4435: 4430: 4420: 4415: 4410: 4409: 4408: 4403: 4393: 4392: 4391: 4386: 4381: 4370: 4368: 4359: 4357:Upper GI tract 4353: 4352: 4344: 4343: 4336: 4329: 4321: 4315: 4314: 4275: 4269: 4261: 4260:External links 4258: 4255: 4254: 4205: 4178:(10): 1110–6. 4162: 4127: 4083: 4047: 4003: 3984:(4): 497–502. 3968: 3917: 3867: 3832: 3784: 3781:on 2006-10-26. 3749: 3706: 3699: 3681: 3674: 3656: 3649: 3631: 3580: 3545: 3496: 3447: 3391: 3362:(10): 1402–7. 3342: 3307: 3263: 3220: 3171: 3120: 3099:(3): 419–437. 3079: 3038: 3011:(8): 1475–81. 2994: 2975:(7): 1028–34. 2959: 2940:(6): 1637–44. 2924: 2886: 2850: 2801: 2752: 2731:(12): 2495–9. 2711: 2684:(6): 399–404. 2668: 2666: 2665: 2636: 2610:(11): 1141–4. 2597: 2596: 2559: 2530: 2501: 2475:(10): 577–82. 2464: 2438:(6): 399–404. 2419: 2367: 2313: 2272: 2263: 2211: 2168: 2141:(11): 3295–8. 2125: 2076: 2047:(3): 153–158. 2024: 1997:(6): 441–448. 1981: 1962: 1955: 1935: 1913: 1900:"Pancreatitis" 1891: 1853: 1852: 1850: 1847: 1846: 1845: 1840: 1833: 1830: 1812: 1809: 1804: 1803: 1800: 1797: 1794: 1791: 1783: 1780: 1779: 1778: 1775: 1772: 1769: 1766: 1763: 1760: 1757: 1748: 1745: 1735: 1734: 1731: 1727: 1726: 1723: 1719: 1718: 1715: 1711: 1710: 1707: 1703: 1702: 1699: 1688: 1687: 1684: 1681: 1677: 1676: 1673: 1670: 1666: 1665: 1662: 1659: 1655: 1654: 1651: 1648: 1644: 1643: 1640: 1637: 1633: 1632: 1629: 1626: 1609: 1606: 1605: 1604: 1601: 1588: 1584: 1581: 1571: 1568: 1563: 1548:Main article: 1545: 1542: 1532:Ranson's score 1528: 1525: 1517: 1516: 1513: 1510: 1507: 1504: 1501: 1496: 1493: 1492: 1491: 1488: 1485: 1482: 1479: 1474: 1471: 1463:Main article: 1460: 1457: 1456: 1455: 1451: 1450: 1408: 1405: 1404: 1403: 1396: 1391: 1390:Other measures 1388: 1387: 1386: 1383: 1380: 1377: 1370: 1369: 1366: 1357: 1354: 1350: 1349: 1346: 1329: 1326: 1317: 1314: 1309: 1306: 1286: 1283: 1254: 1251: 1221: 1218: 1205: 1202: 1197: 1194: 1174: 1171: 1163:cholelithiasis 1139: 1136: 1131: 1130: 1123: 1120: 1110: 1109: 1106: 1103: 1096: 1095: 1092: 1089: 1086: 1083: 1060: 1057: 1049: 1048: 1044: 1043: 1036: 1035: 1034: 1033: 1030: 1024: 1021: 1018: 1015: 1002: 999: 998: 997: 992: 986: 981: 975: 970: 959: 956: 955: 954: 950: 926: 923: 901: 900:Histopathology 898: 881: 878: 840: 837: 824: 821: 820: 819: 813: 804: 799: 794: 791: 782: 777: 772: 767: 765:bypass surgery 758: 753: 751:Scorpion venom 746: 743: 742: 741: 735: 730: 725: 719:choledochocele 715: 685: 667:mercaptopurine 615: 602: 599: 596: 589: 571: 568: 562: 553: 550: 548: 545: 544: 543: 542: 541: 538: 530: 529: 528: 518: 517: 516: 511: 506: 496: 495: 494: 488: 483: 480:encephalopathy 468: 467: 466: 461: 451: 450: 449: 446: 443: 435: 434: 433: 428: 423: 418: 409: 399: 398: 397: 395:Kidney failure 392: 384: 383: 382: 356: 355: 354: 292: 289: 288: 287: 283: 272: 265: 258: 251: 248: 242: 231: 228: 224: 223: 218: 213: 208: 202: 193: 187: 182: 177: 172: 167: 158: 155: 153: 150: 65: 64: 55: 49: 48: 41: 40: 32: 31: 28: 24: 23: 15: 9: 6: 4: 3: 2: 5757: 5746: 5743: 5741: 5740:Inflammations 5738: 5736: 5733: 5731: 5728: 5727: 5725: 5709: 5706: 5702: 5701: 5697: 5695: 5691: 5690: 5686: 5685: 5682: 5678: 5671: 5667: 5666: 5662: 5660: 5656: 5655: 5651: 5647: 5645: 5641: 5640: 5636: 5632: 5631: 5628: 5623: 5619: 5603: 5600: 5598: 5595: 5591: 5588: 5587: 5586: 5583: 5582: 5580: 5578: 5574: 5566: 5563: 5561: 5558: 5556: 5553: 5552: 5551: 5548: 5547: 5542: 5539: 5537: 5534: 5533: 5532: 5531: 5527: 5526: 5523: 5520: 5518: 5515: 5513: 5510: 5508: 5505: 5501: 5498: 5496: 5493: 5492: 5491: 5488: 5487: 5484: 5481: 5477: 5474: 5473: 5472: 5471:Diaphragmatic 5469: 5468: 5466: 5464: 5460: 5457: 5453: 5443: 5440: 5438: 5435: 5433: 5430: 5426: 5423: 5421: 5418: 5416: 5413: 5411: 5408: 5407: 5406: 5403: 5402: 5400: 5398: 5394: 5388: 5385: 5381: 5378: 5376: 5373: 5372: 5371: 5370: 5366: 5365: 5362: 5359: 5357: 5354: 5352: 5348: 5345: 5341: 5338: 5336: 5333: 5331: 5328: 5327: 5326: 5323: 5322: 5320: 5318: 5312: 5308: 5302: 5299: 5297: 5294: 5292: 5289: 5287: 5284: 5282: 5279: 5277: 5276:Cholecystitis 5274: 5273: 5271: 5269: 5265: 5257: 5254: 5252: 5249: 5248: 5247: 5244: 5242: 5239: 5237: 5234: 5230: 5227: 5225: 5222: 5221: 5220: 5219:Liver abscess 5217: 5213: 5210: 5208: 5205: 5204: 5203: 5202:Liver failure 5200: 5198: 5195: 5191: 5188: 5186: 5183: 5181: 5178: 5176: 5173: 5172: 5171: 5170: 5166: 5162: 5159: 5158: 5157: 5154: 5150: 5147: 5146: 5145: 5142: 5138: 5135: 5133: 5130: 5128: 5125: 5124: 5123: 5120: 5119: 5117: 5115: 5111: 5108: 5106: 5102: 5094: 5091: 5090: 5089: 5086: 5082: 5079: 5077: 5074: 5073: 5072: 5069: 5067: 5064: 5063: 5061: 5059: 5055: 5045: 5042: 5040: 5037: 5035: 5032: 5030: 5027: 5025: 5021: 5018: 5017: 5015: 5013: 5009: 5003: 5000: 4998: 4995: 4993: 4990: 4988: 4985: 4981: 4978: 4977: 4976: 4973: 4972: 4970: 4968: 4964: 4958: 4955: 4951: 4948: 4947: 4946: 4943: 4939: 4936: 4935: 4934: 4931: 4929: 4926: 4924: 4921: 4919: 4916: 4914: 4910: 4907: 4905: 4902: 4900: 4897: 4895: 4891: 4890: 4886: 4882: 4879: 4878: 4877: 4874: 4872: 4869: 4865: 4862: 4861: 4860: 4859:Enterocolitis 4857: 4856: 4854: 4850: 4844: 4840: 4836: 4833: 4831: 4827: 4824: 4820: 4816: 4813: 4811: 4808: 4807: 4806: 4803: 4801: 4798: 4794: 4791: 4789: 4786: 4784: 4781: 4779: 4776: 4774: 4771: 4769: 4766: 4765: 4764: 4761: 4759: 4756: 4755: 4753: 4750: 4746: 4741: 4737: 4731: 4728: 4726: 4723: 4721: 4718: 4716: 4713: 4711: 4708: 4706: 4703: 4701: 4698: 4696: 4693: 4691: 4687: 4686:Malabsorption 4684: 4680: 4677: 4676: 4675: 4672: 4668: 4665: 4663: 4660: 4658: 4655: 4654: 4653: 4650: 4649: 4647: 4644: 4640: 4636: 4631: 4627: 4624: 4622: 4618: 4614: 4602: 4599: 4598: 4597: 4594: 4592: 4589: 4587: 4584: 4582: 4579: 4577: 4574: 4572: 4569: 4567: 4564: 4562: 4561:Gastroparesis 4559: 4557: 4554: 4552: 4549: 4545: 4542: 4541: 4540: 4537: 4533: 4530: 4528: 4527:Cushing ulcer 4525: 4524: 4523: 4520: 4516: 4513: 4511: 4508: 4506: 4503: 4502: 4501: 4498: 4497: 4495: 4493: 4489: 4483: 4480: 4478: 4475: 4473: 4472:Megaesophagus 4470: 4468: 4465: 4463: 4460: 4457: 4454: 4449: 4446: 4444: 4441: 4439: 4436: 4434: 4431: 4429: 4426: 4425: 4424: 4421: 4419: 4416: 4414: 4411: 4407: 4404: 4402: 4399: 4398: 4397: 4394: 4390: 4387: 4385: 4382: 4380: 4377: 4376: 4375: 4372: 4371: 4369: 4367: 4363: 4360: 4358: 4354: 4350: 4342: 4337: 4335: 4330: 4328: 4323: 4322: 4319: 4311: 4307: 4303: 4298: 4293: 4289: 4285: 4281: 4276: 4273: 4270: 4268: 4264: 4263: 4250: 4246: 4241: 4236: 4232: 4228: 4224: 4220: 4216: 4209: 4201: 4197: 4193: 4189: 4185: 4181: 4177: 4173: 4166: 4158: 4154: 4150: 4146: 4142: 4138: 4131: 4123: 4119: 4115: 4111: 4107: 4103: 4099: 4095: 4087: 4079: 4075: 4071: 4067: 4063: 4059: 4051: 4043: 4039: 4035: 4031: 4027: 4023: 4020:(3): 238–42. 4019: 4015: 4012:evaluation". 4007: 3999: 3995: 3991: 3987: 3983: 3979: 3972: 3964: 3960: 3955: 3950: 3945: 3940: 3936: 3932: 3928: 3921: 3913: 3909: 3905: 3901: 3897: 3893: 3889: 3885: 3878: 3871: 3863: 3859: 3855: 3851: 3847: 3843: 3836: 3827: 3823: 3819: 3815: 3811: 3807: 3803: 3799: 3791: 3789: 3780: 3776: 3772: 3768: 3764: 3760: 3753: 3745: 3741: 3737: 3733: 3729: 3725: 3721: 3717: 3710: 3702: 3696: 3692: 3685: 3677: 3671: 3667: 3660: 3652: 3646: 3642: 3635: 3627: 3623: 3618: 3613: 3608: 3603: 3599: 3595: 3591: 3584: 3576: 3572: 3568: 3564: 3561:(6): 806–13. 3560: 3556: 3549: 3541: 3537: 3532: 3527: 3523: 3519: 3516:(3): 816–20. 3515: 3511: 3507: 3500: 3492: 3488: 3484: 3480: 3475: 3470: 3467:(3): 267–73. 3466: 3462: 3458: 3451: 3443: 3439: 3435: 3431: 3426: 3421: 3417: 3413: 3409: 3405: 3398: 3396: 3387: 3383: 3378: 3373: 3369: 3365: 3361: 3357: 3353: 3346: 3338: 3334: 3330: 3326: 3322: 3318: 3311: 3303: 3299: 3295: 3291: 3287: 3283: 3279: 3275: 3274:Pancreatology 3267: 3259: 3255: 3251: 3247: 3243: 3239: 3236:(6): 827–34. 3235: 3231: 3224: 3216: 3212: 3208: 3204: 3199: 3194: 3191:(2): 123–30. 3190: 3186: 3182: 3175: 3167: 3163: 3158: 3153: 3148: 3143: 3139: 3135: 3134:Pancreatology 3131: 3124: 3116: 3112: 3107: 3102: 3098: 3094: 3090: 3083: 3075: 3071: 3066: 3061: 3057: 3053: 3049: 3042: 3034: 3030: 3026: 3022: 3018: 3014: 3010: 3006: 2998: 2990: 2986: 2982: 2978: 2974: 2970: 2963: 2955: 2951: 2947: 2943: 2939: 2935: 2928: 2920: 2916: 2912: 2908: 2905:(5): 322–40. 2904: 2900: 2893: 2891: 2882: 2878: 2874: 2870: 2867:(5): 473–82. 2866: 2862: 2854: 2846: 2842: 2837: 2832: 2828: 2824: 2820: 2816: 2812: 2805: 2797: 2793: 2788: 2783: 2779: 2775: 2772:(2): 99–112. 2771: 2767: 2763: 2756: 2748: 2744: 2739: 2734: 2730: 2726: 2722: 2715: 2707: 2703: 2699: 2695: 2691: 2687: 2683: 2679: 2672: 2662: 2658: 2654: 2650: 2646: 2642: 2637: 2633: 2629: 2625: 2621: 2617: 2613: 2609: 2605: 2600: 2599: 2593: 2589: 2585: 2581: 2577: 2573: 2569: 2565: 2560: 2556: 2552: 2548: 2544: 2540: 2536: 2531: 2527: 2523: 2519: 2515: 2512:(5): 576–80. 2511: 2507: 2502: 2498: 2494: 2490: 2486: 2482: 2478: 2474: 2470: 2465: 2461: 2457: 2453: 2449: 2445: 2441: 2437: 2433: 2428: 2427: 2423: 2415: 2411: 2406: 2401: 2397: 2393: 2389: 2385: 2381: 2374: 2372: 2363: 2359: 2355: 2351: 2346: 2341: 2337: 2333: 2329: 2322: 2320: 2318: 2309: 2305: 2300: 2295: 2292:(5): 1361–6. 2291: 2287: 2283: 2276: 2267: 2259: 2255: 2251: 2247: 2242: 2237: 2233: 2229: 2225: 2218: 2216: 2207: 2203: 2199: 2195: 2191: 2187: 2183: 2179: 2172: 2164: 2160: 2156: 2152: 2148: 2144: 2140: 2136: 2129: 2121: 2117: 2112: 2107: 2103: 2099: 2095: 2091: 2087: 2080: 2072: 2068: 2063: 2058: 2054: 2050: 2046: 2042: 2038: 2031: 2029: 2020: 2016: 2012: 2008: 2004: 2000: 1996: 1992: 1985: 1977: 1973: 1966: 1958: 1952: 1948: 1947: 1939: 1923: 1917: 1902:. 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5156:Fatty liver 5076:Hematemesis 5058:GI bleeding 4864:Necrotizing 4793:Lymphocytic 4788:Collagenous 4783:Microscopic 4720:Steatorrhea 4621:Enteropathy 4467:Inlet patch 4389:Herpetiform 4374:Esophagitis 4290:(6): 1210. 2570:(1): 45–9. 1782:BISAP score 1587:<60 mmHg 1578:tachycardia 1574:Hypotension 1495:At 48 hours 1398:The use of 1316:Antibiotics 1263:dehydration 1259:intravenous 1001:Biochemical 966:Perforated 919:neutrophils 849:trypsinogen 745:Less common 675:salicylates 671:pentamidine 647:linagliptin 643:saxagliptin 639:sitagliptin 552:Most common 499:Hematologic 412:Hypovolemia 407:Arrhythmias 402:Circulatory 376:pneumonitis 368:atelectasis 359:Respiratory 262:epigastrium 216:peritonitis 205:tachycardia 196:hemodynamic 192:(shivering) 129:intravenous 94:alcohol use 27:Other names 5724:Categories 5665:DiseasesDB 5577:Peritoneal 5555:Incisional 5476:Congenital 5420:Hereditary 5397:Pancreatic 5361:Haemobilia 5034:Hemorrhoid 5012:Anal canal 4950:Infectious 4938:Functional 4773:Ulcerative 4657:Duodenitis 4596:Gastrinoma 3425:1874/26559 1906:14 October 1849:References 1822:gallstones 1639:Normal CT 1599:creatinine 1400:octreotide 1253:Bowel rest 1238:Meperidine 1173:Ultrasound 1032:Glycosuria 910:hemorrhage 906:parenchyma 785:Infections 627:furosemide 593:endoscopic 471:Neurologic 255:ecchymosis 5708:radio/521 5700:eMedicine 5565:Richter's 5522:Spigelian 5517:Obturator 5507:Umbilical 5340:Ascending 5311:Bile duct 5144:Cirrhosis 5122:Hepatitis 5105:Accessory 4975:Proctitis 4826:Megacolon 4800:Dysentery 4710:Whipple's 4662:Jejunitis 4652:Enteritis 4539:Dyspepsia 4500:Gastritis 4433:Achalasia 4366:Esophagus 4200:218906363 3842:Radiology 1928:4 October 1733:6 points 1725:4 points 1717:2 points 1709:0 points 1686:4 points 1675:3 points 1664:2 points 1642:0 points 1556:APACHE II 1550:APACHE II 1435:APACHE II 1196:Treatment 989:Pleuritic 984:Pneumonia 925:Diagnosis 890:TNF-alpha 865:apoptosis 861:cathepsin 823:Pathology 780:Pregnancy 659:estrogens 623:thiazides 619:diuretics 605:Carcinoma 540:Arthalgia 491:Blindness 476:Psychosis 364:Hypoxemia 339:Metabolic 330:damage), 328:beta cell 110:recurrent 82:gallstone 53:Specialty 5705:med/1720 5495:Indirect 5490:Inguinal 5224:Pyogenic 5169:Vascular 4945:Diarrhea 4923:Volvulus 4889:Vascular 4828: / 4817: / 4778:Ischemic 4745:Appendix 4635:Duodenum 4505:Atrophic 4379:Candidal 4306:23852306 4249:15205290 4192:11099067 4157:16707751 4122:41655611 4114:19861954 4078:15380848 4042:24245362 4034:17895844 4014:Pancreas 3998:16183486 3963:16273623 3912:20809378 3904:16944038 3826:27166241 3818:12409825 3798:Pancreas 3775:16698595 3744:26047869 3626:18081218 3575:19217608 3540:18616944 3483:19125434 3442:11581054 3434:17573797 3337:23888429 3294:20110744 3250:22781906 3230:Pancreas 3215:38955726 3207:21243452 3166:24054878 3115:38857482 3074:36103415 3025:12924639 2989:18179795 2954:15547203 2919:18853839 2881:17363349 2796:24888393 2706:35768001 2698:15943725 2632:34932274 2624:11156345 2592:21285537 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