06/03/2026
Acute Pancreatitis: High-Yield Notes!
Acute Pancreatic inflammation → Sudden severe epigastric pain (often radiates to back) + ↑ pancreatic enzymes.
🔹 Common Triggers:
→ Gallstones (most common)
→ Alcohol
→ Hypertriglyceridemia (usually very high TG)
→ Drugs (e.g., azathioprine, valproate, thiazides, GLP-1 RA rarely), ERCP, trauma, infection (less common)
🔹 Key Symptoms & Signs:
→ Severe epigastric pain → radiates to back
→ Pain worse after meals, relieved by leaning forward (often)
→ Nausea/vomiting
→ Abdominal tenderness/guarding
→ Fever may occur
→ Tachycardia (often from dehydration/inflammation)
🔹 Lab & Diagnosis Clues:
→ ↑ Lipase (preferred, more specific)
→ ↑ Amylase (may rise)
→ Diagnosis = 2 of 3:
→ Typical abdominal pain
→ Lipase/Amylase ≥3× ULN
→ Imaging (CT/MRI/US) showing pancreatitis
→ US helps look for gallstones; CT if severe/unclear diagnosis or complications
🔹 Severe / Red Flags (Urgent):
→ Hypotension/shock
→ Confusion / extreme weakness
→ Breathing difficulty (ARDS)
→ Grey Turner sign (flank bruising) — rare
→ Cullen sign (periumbilical bruising) — rare
→ Jaundice → suggests gallstone obstruction/cholangitis
🔹 Management (High-yield):
→ Aggressive IV fluids (early), pain control, antiemetics
→ Early enteral feeding when tolerated (avoid prolonged NPO if possible)
→ Treat cause:
→ Gallstone pancreatitis: ERCP if cholangitis/ongoing obstruction; cholecystectomy same admission once stable
→ HyperTG: insulin infusion/plasmapheresis in severe cases (specialist)
→ Antibiotics only if infected necrosis/cholangitis (not routine)
⭐ Exam Tip:
→ Lipase ≥3× ULN + Epigastric pain radiating to back = acute pancreatitis until proven otherwise.
