# Acute Pancreatitis (Emergency Referral) - Category: emergency - Review status: reviewed (every claim checked against a document named on this page) - Sources: Acute Pancreatitis - StatPearls, updated 2 August 2025 - https://www.ncbi.nlm.nih.gov/books/NBK482468/ · No dose - referral pathway, no medicine given in primary care - Verified date: 2026-08 ## Verified against - Acute Pancreatitis - StatPearls, updated 2 August 2025 - https://www.ncbi.nlm.nih.gov/books/NBK482468/ - No dose - referral pathway, no medicine given in primary care ## Treatment metadata - No drug therapy in primary care (Recognition & Referral) ## Complete treatment card ```text ACUTE PANCREATITIS (EMERGENCY REFERRAL) Sources: Acute Pancreatitis - StatPearls, updated 2 August 2025 - https://www.ncbi.nlm.nih.gov/books/NBK482468/ · No dose - referral pathway, no medicine given in primary care Review status: REVIEWED against 2 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (6) - Moderate to severe epigastric pain, often deep, burning, or stabbing, radiating to the back, is the classic complaint [abdominal pain · epigastric pain] - Onset is usually sudden, though alcohol-related cases can build more gradually and less focally - Nausea, vomiting, and loss of appetite commonly go along with the pain [nausea · poor appetite · vomiting] - Heavy alcohol use for more than 5 years is a key history point - Weight loss or new-onset diabetes raises concern for an underlying pancreatic tumor [weight loss] - Family history matters in patients under 30 without an obvious cause, pointing to a genetic predisposition SIGNS - what you find (8) - Fever and a fast heart rate are common; blood pressure can drop in severe disease from fluid shifts or systemic inflammation [fever · tachycardia] - Dry mucous membranes, slow capillary refill, and poor skin turgor point to volume depletion [cold peripheries · dehydration] - Pressing on the epigastrium typically elicits tenderness, guarding, or mild rigidity [guarding] - Reduced bowel sounds suggest ileus, and abdominal distension is more common in severe or necrotizing disease [abdominal distension] - Bruising around the navel or in the flank points toward bleeding into the retroperitoneum [bleeding · bruising] - Jaundice can reflect a blocked bile duct or coexisting cholangitis [jaundice] - A palpable epigastric mass may signal a pseudocyst or fluid collection around the pancreas - Confusion, especially in older patients, can point to severe systemic illness or a metabolic disturbance [confusion] TESTS (12) - Diagnosis under the Revised Atlanta Classification needs at least 2 of 3 defined criteria - A lab criterion: amylase or lipase at least 3 times above the upper limit of normal - An ALT above 150 U/L in the first 48 hours predicts gallstone pancreatitis with over 85% positive predictive value - Right upper quadrant ultrasound should be done in every patient to check for gallstones, dilation, or sludge - The threshold for heavy alcohol use is 4 to 5 alcoholic drinks per day, sustained for a minimum of 5 years - No single lab test confirms alcohol as the cause; history remains the main diagnostic tool - Initial labs should include lipase, amylase, liver function tests, calcium, and triglycerides - Rising BUN and hematocrit can signal inadequate fluid resuscitation and predict worse outcomes - Ultrasound is the preferred first imaging test in every patient to look for a biliary cause - Contrast CT is commonly used to look for pancreatic necrosis, pseudocyst, or infection - Cross-sectional imaging comes into play only if the picture stays unclear, or if a patient is not improving after 48 to 72 hours - Severe disease is defined by organ failure lasting more than 48 hours, necrosis, or systemic complications IF NOT THIS - what else fits (7) - Peptic ulcer disease can mimic pancreatitis and may perforate into peritonitis - Acute cholecystitis overlaps with biliary pancreatitis through right upper quadrant pain and fever - Consider mesenteric ischemia if the pain is severe but the exam findings seem mild by comparison - An inferior-wall MI can present as epigastric pain and vomiting, needing ECG and troponin to exclude - Diabetic ketoacidosis can mimic pancreatitis, causing abdominal pain and a raised amylase - Aortic dissection should be suspected with tearing chest or back pain, unequal pulses, or neurologic signs - In a patient with low blood pressure and back or flank pain, think about a ruptured abdominal aortic aneurysm Source StatPearls "Acute Pancreatitis" - disease-level clinical article Status traced to the source above 1. NO DRUG THERAPY IN PRIMARY CARE (RECOGNITION & REFERRAL)[1st line] Adult Emergency admission. Sudden, severe epigastric pain radiating through to the back, with nausea and vomiting. Diagnosis needs two of three: that pain, a serum amylase or lipase three or more times the upper limit of normal, or imaging. Gallstones and alcohol account for most of it. Do not manage this in the community and do not wait for a lipase result before referring a patient who looks unwell. - Refer, with advice Peds Uncommon in children; trauma, viral infection and drugs are the usual causes. Refer as an emergency. Source No dose - referral pathway, no medicine given in primary care Caution Fluid resuscitation in the first hours is what changes the outcome, and it happens in hospital. StatPearls is explicit that prophylactic antibiotics are avoided in sterile necrosis - do not start an antibiotic on suspicion before transfer. A normal amylase does not exclude it, particularly late in the illness or in hypertriglyceridaemic pancreatitis. Ask about alcohol and about gallstones: the cause changes what happens after discharge, including whether the gallbladder comes out. Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)