Acute pancreatitis

1448:(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 1075: 48: 310:(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. 907:. 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. 839: 1161:(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. 948:, 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. 1053:"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" 1189: 874:), 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: 1304:(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 1459:

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

1247:(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. 927:

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

296:

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.

1627:, 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: 1530:

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".

1434:(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. 3282:

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".

1754:(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. 1308:). 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. 3806:

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.

4290: 1058:"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)" 1335:

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

159:, 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. 1465:

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".

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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".

2000:

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.

870:), where the enzyme assists in the digestion of proteins. During an episode of acute pancreatitis, trypsinogen comes into contact with lysosomal enzymes (specifically 2650:

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.

4487: 932:. Due to the pancreas lacking a capsule, the inflammation and necrosis can extend to include fascial layers in the immediate vicinity of the pancreas. 131:(the term pancreatic dysfunction includes cases of acute or chronic pancreatitis where the pancreas is measurably damaged, even if it has not failed). 1750:

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

3938:"Balthazar computed tomography severity index is superior to Ranson criteria and APACHE II scoring system in predicting acute pancreatitis outcome" 2943:

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

1176:) and duct anomalies. Clinical trials indicate that MRCP can be as effective a diagnostic tool for acute pancreatitis with biliary etiology as 923:). These are produced by intrapancreatic activation of pancreatic enzymes. Lipase activation produces the necrosis of fat tissue in pancreatic 519: 322: 1031:

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

4715: 3709: 3684: 3659: 1965: 1168:(MRCP) sequences. MRCP provides useful information regarding the etiology of acute pancreatitis, i.e., the presence of tiny biliary stones ( 2908:

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).

5345: 641: 5486: 5098: 5081: 4586: 4581: 4458: 3851:

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

1932: 1140:, which becomes visible), pancreatic ascites, pleural effusion (seen on basal cuts of the pleural cavity), adynamic ileus, etc. 915:

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)

5740: 5306: 4825: 4433: 4226:"Hospital admission for acute pancreatitis in an English population, 1963–98: database study of incidence and mortality" 4520: 2822:"Dynamic contrast enhanced computed tomography: a precise technique for identifying and localising pancreatic necrosis" 2293:"Lipase/amylase ratio. A new index that distinguishes acute episodes of alcoholic from nonalcoholic acute pancreatitis" 1449: 882:, which is less organized and more damaging. The balance between these two mechanisms of cellular death is mediated by 5745: 1875: 237:

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

5755: 4886: 4815: 1301: 1158: 5159: 5115: 5068: 4874: 4492: 1200: 1192: 1037:

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

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

47: 1437:

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.

5750: 5510: 5234: 5217: 4627: 4601: 4477: 4428: 4389: 4367: 4359: 2187:

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

665: 474: 286: 3725:

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

5442: 5350: 5311: 5239: 1005: 957: 716: 431: 307: 290: 142:(IV) nutritional support, and intravenous fluid rehydration. Severe cases often require admission to an 5361: 4542: 1614:

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

249: 134:

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

1480:

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

5481: 5425: 5246: 5142: 4725: 4720: 4554: 4472: 4438: 1853: 953: 945: 749: 593: 436: 362: 221: 124: 2731: 1379:

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

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

1312: 1169: 1154: 1083: 766: 441: 426: 210: 143: 1359:

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

1203:, the finding of a hypoechoic and bulky pancreas is regarded as diagnostic of acute pancreatitis. 5587: 5452: 5435: 5407: 5390: 5256: 4783: 4755: 4515: 4411: 4376: 4206: 4128: 4048: 3918: 3832: 3750: 3497: 3448: 3308: 3264: 3221: 3039: 2712: 2638: 2598: 2503: 2466: 2368: 2264: 2212: 2169: 2025: 1892: 1751: 1289: 780: 128: 4891: 4689: 3770:"APACHE system is better than Ranson system in the prediction of severity of acute pancreatitis" 2732:"Combined serum amylase and lipase determinations for diagnosis of suspected acute pancreatitis" 1137: 5704: 5675: 5565: 5546: 4919: 4312: 4255: 4198: 4163: 4120: 4084: 4040: 4004: 3969: 3910: 3868: 3824: 3781: 3742: 3705: 3680: 3655: 3632: 3581: 3546: 3489: 3440: 3392: 3343: 3300: 3256: 3213: 3172: 3121: 3080: 3031: 2995: 2960: 2925: 2887: 2851: 2802: 2753: 2704: 2667: 2630: 2590: 2561: 2532: 2495: 2458: 2420: 2360: 2314: 2256: 2204: 2161: 2126: 2077: 2017: 1961: 1955: 1256: 826: 707: 334: 63: 3888:"Prospective study of 310 patients: can early CT predict the severity of acute pancreatitis?" 5612: 5532: 5527: 5517: 5379: 5251: 5179: 4997: 4904: 4899: 4829: 4788: 4596: 4561: 4302: 4245: 4237: 4190: 4155: 4112: 4076: 4032: 3996: 3959: 3949: 3902: 3860: 3816: 3734: 3622: 3612: 3573: 3536: 3528: 3479: 3430: 3422: 3382: 3374: 3335: 3326:

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

3292: 3248: 3203: 3162: 3152: 3111: 3070: 3023: 2987: 2952: 2917: 2879: 2841: 2833: 2792: 2784: 2743: 2696: 2659: 2622: 2582: 2553: 2524: 2487: 2450: 2410: 2402: 2350: 2304: 2246: 2196: 2153: 2116: 2108: 2067: 2059: 2009: 1884: 941: 817: 799: 733: 693: 619: 569: 382: 255: 190: 156: 135: 108: 96: 68: 5570: 5500: 5366: 5301: 5266: 5137: 5002: 4938: 4840: 4759: 4750: 4700: 4640: 4525: 4502: 2097:"Clinical implications and risk factors of acute pancreatitis after cardiac valve surgery" 1542: 1475: 1441: 1323:

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

812: 711: 703: 279: 174: 100: 72: 4327: 4320: 3361:

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

2773:"Significant elevations of serum lipase not caused by pancreatitis: a systematic review" 5607: 5522: 5076: 5049: 4914: 4849: 4845: 4735: 4705: 4307: 3964: 3937: 3627: 3600: 3541: 3516: 3387: 3362: 2846: 2821: 2797: 2772: 2415: 2390: 2121: 2096: 2072: 2047: 1173: 1096:

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

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

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to determine therapeutic response after surgery or interventional radiologic procedure

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

2029: 5715: 5415: 5327: 5200: 5103: 5054: 5039: 5034: 5030: 4943: 4768: 4684: 4576: 4566: 4532: 3501: 3339: 3312: 3268: 3100:"American College of Gastroenterology Guidelines: Management of Acute Pancreatitis" 3043: 2372: 978: 924: 887:

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

785: 738: 673: 661: 645: 597: 524: 354: 326: 206: 152: 84: 56: 17: 3577: 3116: 3099: 2748: 2235:"American College of Gastroenterology guideline: management of acute pancreatitis" 4036: 3532: 3252: 1839:

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

5718: 5699: 5595: 5357: 5335: 5166: 5086: 4730: 4631: 4384: 4080: 2528: 1588: 1584: 1273: 1269: 1180:, but with the benefits of being less invasive and causing fewer complications. 929: 859: 685: 681: 657: 653: 649: 422: 417: 386: 378: 272: 226: 215: 139: 104: 2956: 2921: 285:

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

5680: 5371: 5044: 5022: 4667: 4606: 4241: 3906: 3601:"Role of endoscopic retrograde cholangiopancreatography in acute pancreatitis" 3208: 3191: 3157: 3140: 3027: 2991: 2883: 2837: 2112: 2013: 1982: 1694:

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

1609: 1534:

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

1520:

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

1410: 1248: 1157:

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

920: 916: 637: 268:, large bruise, around the umbilicus due to local toxic lesion of the vessels) 265: 3954: 3936:

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

3617: 1284:

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

1126:

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

5710: 5654: 5321: 5291: 5154: 5132: 4985: 4836: 4810: 4672: 4662: 4549: 4510: 4443: 4194: 3517:"The impact of hospital-acquired infection on outcome in acute pancreatitis" 3141:"IAP/APA evidence-based guidelines for the management of acute pancreatitis" 2406: 1832: 1566: 1560: 1445: 1393:

Closed management – necrosectomy with closed continuous postoperative lavage

1109:

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

994: 900: 875: 871: 838: 795: 790: 669: 633: 629: 615: 501: 486: 374: 338: 92: 4316: 4259: 4202: 4167: 4124: 4088: 4044: 4008: 3973: 3914: 3828: 3785: 3636: 3585: 3550: 3493: 3444: 3378: 3347: 3304: 3260: 3217: 3176: 3167: 3125: 3084: 3035: 2999: 2964: 2929: 2891: 2806: 2708: 2634: 2499: 2462: 2424: 2364: 2260: 2208: 2165: 2130: 2081: 2021: 3872: 3746: 3396: 3075: 3058: 2855: 2757: 2671: 2626: 2594: 2565: 2536: 2318: 4955: 4933: 4645: 4159: 4116: 3789: 2251: 2234: 1601: 1305: 1252: 1244: 999: 883: 879: 867: 855: 843: 771: 689: 496: 469: 185: 88: 4277: 3886:

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

1276:, and sufficient pain control. As the pancreas is stimulated to secrete 5007: 4773: 4677: 4649: 2663: 1896: 1576: 1285: 1018: 863: 821: 722: 575: 148: 120: 5637: 3435: 3296: 2788: 1935:. The National Institute of Diabetes and Digestive and Kidney Diseases 1102:

there is no improvement after 72 hours of conservative medical therapy

5649: 5473: 5091: 4977: 3484: 3467: 2200: 2041: 2039: 1277: 1022: 623: 514: 231: 200: 180: 112: 2063: 1888: 1049:

Regarding selection on these tests, two practice guidelines state:

4923: 4653: 3059:"Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis" 1836: 1376:

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

1187: 1073: 837: 699: 195: 116: 4146:

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

1511:

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

1343:

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

1300:

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

919:, focal enzymic necrosis of pancreatic fat and vessel necrosis ( 4331: 1672:

Pancreatic gland abnormalities and peripancreatic inflammation

1105:

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

1605: 3677:

Current Obstetric & Gynecologic Diagnosis & Treatment

3139:

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

1356:

Clinical deterioration or lack of improvement after 24 hours

1136:

Locoregional – Gerota's fascia sign (thickening of inflamed

261:

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

177:(upper abdominal pain) radiating to the back in 50% of cases 2291:

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

1390:

Conventional management – necrosectomy with simple drainage

1119:

before discharge in patients with severe acute pancreatitis

1063:

tests were combined with a discriminant function equation.

1807:

Evidence of SIRS (systemic inflammatory response syndrome)

1255:

because of the belief that morphine caused an increase in

568:

Biliary pancreatitis due to gallstones or constriction of

2730:

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

2233:

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

1495:

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

960:, liver function, serum calcium, serum amylase and lipase 862:. Normally, trypsinogen is converted to its active form ( 3515:

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

2391:"UK guidelines for the management of acute pancreatitis" 3468:"Timing and impact of infections in acute pancreatitis" 1987:

Surgical Treatment: Evidence-Based and Problem-Oriented

1804:

Abnormal mental status with a Glasgow coma score <15

1292:

prior to oral refeeding. IMRIE scoring is also useful.

2228: 2226: 1418:

Classification by severity: prognostic scoring systems

456:

Gastric varices (secondary to splenic vein thrombosis)

119:. Acute pancreatitis may be a single event; it may be 3841:(comment=this study used an Apache cutoff of >=10) 3774:

Hepatobiliary & Pancreatic Diseases International

2048:"Review of Infectious Etiology of Acute Pancreatitis" 1981:

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

1873:

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

1099:

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

5627: 3700:

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

3363:"Effects of morphine on the human sphincter of Oddi" 1569:) score > 8 points predicts 11% to 18% mortality 1406:

Pancreatic enzyme inhibitors are proven not to work.

5690: 5631: 5586: 5472: 5465: 5406: 5320: 5277: 5123: 5114: 5067: 5021: 4976: 4862: 4749: 4639: 4626: 4501: 4375: 4366: 4291:"Cullen's sign for acute haemorrhagic pancreatitis" 2609:Without support for the superiority of the lipase: 2389:UK Working Party on Acute Pancreatitis (May 2005). 1145:surgical or percutaneous debridement is indicated. 62: 37: 32: 1983:"Early complications of severe acute pancreatitis" 1623:Developed in the early 1990s by Emil J. Balthazar 1565:"Acute Physiology And Chronic Health Evaluation" ( 858:(or proenzymes) inside the pancreas, most notably 453:Gastrointestinal hemorrhage from stress ulceration 245:The following are associated with severe disease: 3702:The Trauma Manual: Trauma and Acute Care Surgery 2046:Rawla P, Bandaru SS, Vellipuram AR (June 2017). 1523:Base deficit (negative base excess) > 4 mEq/L 1383:Surgical options for infected necrosis include: 1093:the diagnosis of acute pancreatitis is uncertain 896:pancreas, and nearby organs may become injured. 3801: 3799: 3408: 3406: 3192:"Early management of severe acute pancreatitis" 2903: 2901: 2820:Larvin M, Chalmers AG, McMahon MJ (June 1990). 2384: 2382: 2332: 2330: 2328: 1352:mortality. The indications for early ERCP are: 1164:Another advantage of MRI is its utilization of 278:Kamenchik's sign (pain with pressure under the 4276:Banks et al. Modified Marshall scoring system 2771:Hameed AM, Lam VW, Pleass HC (February 2015). 1345:Endoscopic retrograde cholangiopancreatography 1339:Endoscopic retrograde cholangiopancreatography 1178:endoscopic retrograde cholangiopancreatography 4343: 2437:In support of the superiority of the lipase: 1782:E – Enzymes: LDH >600iu/L; AST >200iu/L 1661:Focal or diffuse enlargement of the pancreas 8: 4449:Esophagogastric junction outflow obstruction 866:) in the first part of the small intestine ( 258:(hemorrhagic discoloration of the umbilicus) 91:. Causes, in order of frequency, include: a 3989:Journal of the American College of Surgeons 3328:The Cochrane Database of Systematic Reviews 2339:"Practice guidelines in acute pancreatitis" 1788:S – Sugar: blood glucose >10 mmol/L 1779:R – Renal function: Urea >16 mmol/L 1492:white blood cell count > 16000 cells/mm3 1166:magnetic resonance cholangiopancreatography 878:, which is physiologically controlled, and 5628: 5469: 5120: 4636: 4488:Esophageal intramural pseudodiverticulosis 4372: 4350: 4336: 4328: 2615:Clinical Chemistry and Laboratory Medicine 46: 29: 4306: 4249: 3963: 3953: 3626: 3616: 3540: 3483: 3434: 3386: 3207: 3190:Talukdar R, Swaroop Vege S (April 2011). 3166: 3156: 3115: 3074: 2845: 2796: 2747: 2414: 2354: 2308: 2250: 2120: 2071: 504:(angiopathic retinopathy with hemorrhage) 252:(hemorrhagic discoloration of the flanks) 55:Still from 3D medical animation of acute 4289:Parikh, RP; Upadhyay, KJ (Jul 4, 2013). 4183:Scandinavian Journal of Gastroenterology 4105:The American Journal of Gastroenterology 3415:The American Journal of Gastroenterology 2343:The American Journal of Gastroenterology 2239:The American Journal of Gastroenterology 2146:The American Journal of Gastroenterology 1705: 1632: 1985:. In Holzheimer RG, Mannick JA (eds.). 1933:"Symptoms & Causes of Pancreatitis" 1865: 1801:BUN >25 mg/dL (8.9 mmol/L) 1432:systemic inflammatory response syndrome 1413:has been shown not to improve outcomes. 3599:Canlas KR, Branch MS (December 2007). 2945:AJR. American Journal of Roentgenology 1813:Imaging study reveals pleural effusion 1683:Fluid collection in a single location 940:Acute pancreatitis is diagnosed using 520:Disseminated intravascular coagulation 323:disseminated intravascular coagulation 4716:Small intestinal bacterial overgrowth 4224:Goldacre MJ, Roberts SE (June 2004). 3768:Yeung YP, Lam BY, Yip AW (May 2006). 3704:. Lippincott Williams & Wilkins. 3650:Apostolakos MJ, Papadakos PJ (2001). 973:The differential diagnosis includes: 7: 2546:Journal of Clinical Gastroenterology 2002:Clinical Journal of Gastroenterology 1773:N – Neutrophilia: WCC >15x10(9)/L 4148:The New England Journal of Medicine 1517:Oxygen (hypoxemia PO2 < 60 mmHg) 1251:has been historically favored over 928:Inflammatory infiltrate is rich in 606:retrograde cholangiopancreatography 391:acute respiratory distress syndrome 337:(from pancreatic insulin-producing 335:insulin dependent diabetes mellitus 319:multiple organ dysfunction syndrome 315:acute respiratory distress syndrome 306:Locoregional complications include 275:, 6–7 cm above the umbilicus)) 2910:Seminars in Ultrasound, CT and MRI 289:and below the left 12th rib (left 25: 5601:Spontaneous bacterial peritonitis 5448:Exocrine pancreatic insufficiency 4001:10.1016/j.jamcollsurg.2005.06.269 3942:World Journal of Gastroenterology 3605:World Journal of Gastroenterology 1960:. JP Medical Ltd. pp. 488–. 1957:SRB's Clinical Methods in Surgery 537:Painful subcutaneous fat necrosis 5346:Secondary sclerosing cholangitis 3821:10.1097/00006676-200211000-00002 3427:10.1111/j.1572-0241.2007.01357.x 3196:Current Gastroenterology Reports 2701:10.1111/j.1445-2197.2005.03391.x 2587:10.1097/00006676-199801000-00008 2558:10.1097/00004836-198902000-00011 2492:10.1046/j.1445-2197.2001.02220.x 2455:10.1111/j.1445-2197.2005.03391.x 2356:10.1111/j.1572-0241.2006.00856.x 2189:Allergologia et Immunopathologia 2158:10.1111/j.1572-0241.2000.03213.x 1526:Sequestration of fluids > 6 L 4587:Gastric antral vascular ectasia 4582:Portal hypertensive gastropathy 4459:Gastroesophageal reflux disease 3865:10.1148/radiology.174.2.2296641 3675:DeCherney AH, Lauren N (2003). 3016:Digestive Diseases and Sciences 1430:Necrosis will be followed by a 402:Renal artery or vein thrombosis 313:Systemic complications include 5341:Primary sclerosing cholangitis 5191:Hepatic veno-occlusive disease 5013:Solitary rectal ulcer syndrome 3472:The British Journal of Surgery 3340:10.1002/14651858.CD009179.pub2 493:(confusion, delusion and coma) 1: 5398:Sphincter of Oddi dysfunction 4069:European Journal of Radiology 3739:10.1016/S0140-6736(89)90381-4 3578:10.1016/j.amjsurg.2008.08.016 3117:10.14309/ajg.0000000000002645 2281:Bailey & Love's/24th/1123 1785:A – Albumin <32g/L (serum) 1776:C – Calcium <2 mmol/L 1086:, practice guidelines state: 581:Idiopathic in 15–25% of cases 264:Grünwald sign (appearance of 5307:Postcholecystectomy syndrome 4826:Intestinal pseudoobstruction 4434:Esophageal motility disorder 4037:10.1097/MPA.0b013e3180619662 3679:. McGraw-Hill Professional. 3654:. McGraw-Hill Professional. 3533:10.1053/j.gastro.2008.05.053 3253:10.1097/MPA.0b013e31824c1598 2310:10.1016/0016-5085(91)90089-4 1954:Sriram Bhat M (2018-10-31). 1810:Patient age >60 years old 1604:(<50 mL/h) or increasing 1573:Hemorrhagic peritoneal fluid 798:other than mumps, including 459:Gastrointestinal obstruction 4081:10.1016/j.ejrad.2003.10.006 3566:American Journal of Surgery 3057:Enrique de-Madaria (2022). 2872:Digestive and Liver Disease 2749:10.1093/clinchem/39.12.2495 2529:10.7326/0003-4819-102-5-576 2517:Annals of Internal Medicine 1876:American Journal of Nursing 1581:Indicators of organ failure 1455:Practice guidelines state: 329:(from fat saponification), 99:beyond the point where the 5772: 5292:Gallstone / Cholelithiasis 4816:Functional colonic disease 4612:Zollinger–Ellison syndrome 2980:Gastrointestinal Endoscopy 2957:10.2214/ajr.183.6.01831637 2922:10.1053/j.sult.2008.06.009 1558: 1489:age in years > 55 years 1473: 1302:total parenteral nutrition 1159:magnetic resonance imaging 1149:Magnetic resonance imaging 728:Structural abnormalities: 4493:Acute esophageal necrosis 4242:10.1136/bmj.328.7454.1466 3907:10.1007/s00261-006-9034-y 3652:The Intensive Care Manual 3421:(9): 2079–84, quiz 2085. 3209:10.1007/s11894-010-0174-4 3158:10.1016/j.pan.2013.07.063 2992:10.1016/j.gie.2007.09.007 2884:10.1016/j.dld.2007.01.015 2838:10.1136/bmj.300.6737.1425 2113:10.3349/ymj.2013.54.1.154 2052:Gastroenterology Research 2014:10.1007/s12328-018-0881-1 1201:abdominal ultrasonography 1193:Abdominal ultrasonography 548:Subcutaneous fat necrosis 54: 45: 41:Acute pancreatic necrosis 4592:Gastric dumping syndrome 4467:Laryngopharyngeal reflux 4454:Diffuse esophageal spasm 3955:10.3748/wjg.v11.i38.6049 3618:10.3748/wjg.v13.i47.6314 1770:A – Age >55-years-old 1538:Alternative Ranson score 345:due to exocrine failure 123:; or it may progress to 5208:Alcoholic liver disease 4741:Bile acid malabsorption 4685:Peptic (duodenal) ulcer 4195:10.1080/003655200451261 4111:(2): 435–41, quiz 442. 3028:10.1023/A:1024747319606 2652:Mayo Clinic Proceedings 2407:10.1136/gut.2004.057026 1989:. Munich: Zuckschwerdt. 1514:Hematocrit fall >10% 1501:serum LDH > 350 IU/L 1498:serum AST > 250 IU/L 1082:Regarding the need for 1040:Decreased serum calcium 952:Blood investigations – 744:Autoimmune pancreatitis 586:hereditary pancreatitis 209:instability, including 5218:Hepatic encephalopathy 4602:Buried bumper syndrome 4533:Peptic (gastric) ulcer 4417:Mallory–Weiss syndrome 4360:human digestive system 3379:10.1136/gut.29.10.1402 2689:ANZ Journal of Surgery 2480:ANZ Journal of Surgery 2443:ANZ Journal of Surgery 2101:Yonsei Medical Journal 1349:biliary sphincterotomy 1347:(ERCP) with empirical 1313:intubating the trachea 1196: 1113:acute change in status 1079: 969:Differential diagnosis 846: 594:elevated triglycerides 475:Portal vein thrombosis 287:erector spinae muscles 5443:Pancreatic pseudocyst 5312:Porcelain gallbladder 4424:Zenker's diverticulum 3098:Scott Tenner (2024). 3076:10.1056/NEJMoa2202884 2627:10.1515/CCLM.2000.173 1587:(SBP <90 mmHG) or 1423:severe pancreatitis. 1195:of acute pancreatitis 1191: 1077: 1006:Myocardial infarction 958:kidney function tests 841: 717:Mycoplasma pneumoniae 584:Metabolic disorders: 432:Myocardial infarction 308:pancreatic pseudocyst 5247:Hepatorenal syndrome 5186:Budd–Chiari syndrome 5143:Autoimmune hepatitis 4968:Intestinal adhesions 4726:Short bowel syndrome 4555:Functional dyspepsia 4473:Esophageal stricture 4439:Nutcracker esophagus 4160:10.1056/NEJMcp054958 4117:10.1038/ajg.2009.622 3151:(4 Suppl 2): e1–15. 2252:10.1038/ajg.2013.218 2245:(9): 1400–15, 1416. 1854:Chronic pancreatitis 1763:mnemonic, PANCREAS: 954:complete blood count 946:physical examination 750:hypertriglyceridemia 437:Pericardial effusion 363:hypertriglyceridemia 291:costovertebral angle 222:respiratory distress 125:chronic pancreatitis 115:; and, in children, 5741:Medical emergencies 5386:Choledocholithiasis 5257:Metabolic disorders 5223:Acute liver failure 5196:Portal hypertension 5148:Alcoholic hepatitis 4991:Radiation proctitis 4910:Mesenteric ischemia 4882:Gastroenterocolitis 4711:Blind loop syndrome 4521:Ménétrier's disease 4429:Barrett's esophagus 2401:(Suppl 3): iii1–9. 1849:Canine pancreatitis 1733:30 to 50% necrosis 1709:Necrosis percentage 1296:Nutritional support 1170:choledocholithiasis 1155:computed tomography 1084:computed tomography 1070:Computed tomography 804:Hyperparathyroidism 781:Heart valve surgery 767:Chinese liver fluke 442:Vascular thrombosis 144:intensive care unit 18:Pancreatic necrosis 5746:Pancreas disorders 5691:External resources 5561:Undefined location 5552:Grynfeltt–Lesshaft 5453:Pancreatic fistula 5436:Pancreatic abscess 5391:Biliary dyskinesia 5362:Mirizzi's syndrome 4863:Large and/or small 4543:Dieulafoy's lesion 4412:Boerhaave syndrome 3104:Am J Gastroenterol 2736:Clinical Chemistry 2664:10.4065/71.12.1138 1752:C-reactive protein 1741:Over 50% necrosis 1725:0 to 30% necrosis 1290:parenteral feeding 1272:fluids to prevent 1197: 1080: 847: 612:Penetrating ulcers 250:Grey-Turner's sign 163:Signs and symptoms 129:pancreatic failure 81:Acute pancreatitis 33:Acute pancreatitis 5756:Medical mnemonics 5728: 5727: 5625: 5624: 5621: 5620: 5461: 5460: 5063: 5062: 4920:Bowel obstruction 4622: 4621: 4278:online calculator 3895:Abdominal Imaging 3711:978-0-7817-6275-5 3686:978-0-8385-1401-6 3661:978-0-07-006696-0 3297:10.1159/000210022 2789:10.1111/hpb.12277 1967:978-93-5270-545-0 1883:(12): 1157–1161. 1767:P – PaO2 <8kPa 1748: 1747: 1701: 1700: 1639:Appearance on CT 1591:> 130 beat/min 1257:sphincter of Oddi 1215:Fluid replacement 827:Codeine phosphate 708:coxsackie B virus 497:Cerebral Embolism 218:(rapid heartbeat) 83:(AP) is a sudden 78: 77: 27:Medical condition 16:(Redirected from 5763: 5629: 5613:Pneumoperitoneum 5470: 5380:Common bile duct 5262:Wilson's disease 5252:Peliosis hepatis 5121: 4998:Proctalgia fugax 4905:Abdominal angina 4830:Ogilvie syndrome 4779:Pseudomembranous 4637: 4597:Gastric volvulus 4562:Pyloric stenosis 4373: 4358:Diseases of the 4352: 4345: 4338: 4329: 4324: 4323:on Dec 23, 2017. 4319:. Archived from 4310: 4295:Indian J Med Res 4264: 4263: 4253: 4236:(7454): 1466–9. 4221: 4215: 4214: 4178: 4172: 4171: 4143: 4137: 4136: 4099: 4093: 4092: 4063: 4057: 4056: 4019: 4013: 4012: 3984: 3978: 3977: 3967: 3957: 3933: 3927: 3926: 3892: 3883: 3877: 3876: 3848: 3842: 3840: 3803: 3794: 3793: 3788:. Archived from 3765: 3759: 3758: 3722: 3716: 3715: 3697: 3691: 3690: 3672: 3666: 3665: 3647: 3641: 3640: 3630: 3620: 3596: 3590: 3589: 3561: 3555: 3554: 3544: 3521:Gastroenterology 3512: 3506: 3505: 3487: 3485:10.1002/bjs.6447 3463: 3457: 3456: 3438: 3410: 3401: 3400: 3390: 3358: 3352: 3351: 3323: 3317: 3316: 3279: 3273: 3272: 3236: 3230: 3229: 3211: 3187: 3181: 3180: 3170: 3160: 3136: 3130: 3129: 3119: 3095: 3089: 3088: 3078: 3069:(11): 989–1000. 3054: 3048: 3047: 3010: 3004: 3003: 2975: 2969: 2968: 2940: 2934: 2933: 2905: 2896: 2895: 2866: 2860: 2859: 2849: 2832:(6737): 1425–8. 2817: 2811: 2810: 2800: 2768: 2762: 2761: 2751: 2727: 2721: 2720: 2684: 2678: 2675: 2646: 2606: 2569: 2540: 2511: 2474: 2435: 2429: 2428: 2418: 2386: 2377: 2376: 2358: 2349:(10): 2379–400. 2334: 2323: 2322: 2312: 2297:Gastroenterology 2288: 2282: 2279: 2273: 2272: 2254: 2230: 2221: 2220: 2201:10.1157/13075703 2184: 2178: 2177: 2141: 2135: 2134: 2124: 2092: 2086: 2085: 2075: 2043: 2034: 2033: 1997: 1991: 1990: 1978: 1972: 1971: 1951: 1945: 1944: 1942: 1940: 1929: 1923: 1922: 1920: 1918: 1907: 1901: 1900: 1870: 1706: 1642:CT grade points 1636:Balthazar grade 1633: 1630:Balthazar grade 942:clinical history 800:varicella zoster 734:pancreas divisum 694:sodium valproate 620:head of pancreas 609:Abdominal trauma 570:ampulla of Vater 449:Gastrointestinal 191:loss of appetite 157:carboxypeptidase 136:nothing by mouth 109:systemic disease 103:joins it; heavy 97:common bile duct 95:impacted in the 69:Gastroenterology 50: 30: 21: 5771: 5770: 5766: 5765: 5764: 5762: 5761: 5760: 5731: 5730: 5729: 5724: 5723: 5686: 5685: 5640: 5626: 5617: 5582: 5571:Internal hernia 5457: 5402: 5367:Biliary fistula 5325: 5316: 5302:Adenomyomatosis 5297:Cholesterolosis 5273: 5267:Hemochromatosis 5138:Viral hepatitis 5110: 5059: 5017: 5003:Rectal prolapse 4972: 4939:Fecal impaction 4929:Intussusception 4892:Crohn's disease 4858: 4841:Toxic megacolon 4753: 4751:Large intestine 4745: 4690:Curling's ulcer 4643: 4641:Small intestine 4630: 4618: 4526:Gastroenteritis 4497: 4362: 4356: 4288: 4283:Pathology Atlas 4273: 4268: 4267: 4223: 4222: 4218: 4180: 4179: 4175: 4154:(20): 2142–50. 4145: 4144: 4140: 4101: 4100: 4096: 4065: 4064: 4060: 4021: 4020: 4016: 3986: 3985: 3981: 3948:(38): 6049–52. 3935: 3934: 3930: 3890: 3885: 3884: 3880: 3850: 3849: 3845: 3805: 3804: 3797: 3767: 3766: 3762: 3733:(8656): 201–5. 3724: 3723: 3719: 3712: 3699: 3698: 3694: 3687: 3674: 3673: 3669: 3662: 3649: 3648: 3644: 3611:(47): 6314–20. 3598: 3597: 3593: 3563: 3562: 3558: 3514: 3513: 3509: 3465: 3464: 3460: 3412: 3411: 3404: 3360: 3359: 3355: 3334:(7): CD009179. 3325: 3324: 3320: 3281: 3280: 3276: 3238: 3237: 3233: 3189: 3188: 3184: 3168:1854/LU-8582111 3138: 3137: 3133: 3097: 3096: 3092: 3056: 3055: 3051: 3012: 3011: 3007: 2977: 2976: 2972: 2942: 2941: 2937: 2907: 2906: 2899: 2868: 2867: 2863: 2819: 2818: 2814: 2770: 2769: 2765: 2729: 2728: 2724: 2686: 2685: 2681: 2658:(12): 1138–44. 2649: 2612: 2572: 2543: 2514: 2477: 2440: 2436: 2432: 2388: 2387: 2380: 2336: 2335: 2326: 2290: 2289: 2285: 2280: 2276: 2232: 2231: 2224: 2186: 2185: 2181: 2143: 2142: 2138: 2094: 2093: 2089: 2064:10.14740/gr858w 2045: 2044: 2037: 1999: 1998: 1994: 1980: 1979: 1975: 1968: 1953: 1952: 1948: 1938: 1936: 1931: 1930: 1926: 1916: 1914: 1909: 1908: 1904: 1889:10.2307/3412015 1872: 1871: 1867: 1862: 1845: 1824: 1795: 1760: 1703:Necrosis score 1621: 1619:Balthazar score 1597: 1563: 1557: 1555:APACHE II score 1540: 1508: 1486: 1478: 1476:Ranson criteria 1472: 1442:Ranson criteria 1420: 1403: 1369: 1341: 1329: 1321: 1298: 1266: 1233: 1220:pancreatitis. 1217: 1209: 1186: 1151: 1138:Gerota's fascia 1072: 1017:Elevated serum 1014: 971: 938: 913: 893: 891:Pathophysiology 852: 842:Anatomy of the 836: 813:Cystic fibrosis 758: 712:cytomegalovirus 704:viral hepatitis 578:in 30% of cases 572:in 40% of cases 565: 560: 304: 280:xiphoid process 243: 175:epigastric pain 170: 165: 101:pancreatic duct 73:general surgery 28: 23: 22: 15: 12: 11: 5: 5769: 5767: 5759: 5758: 5753: 5748: 5743: 5733: 5732: 5726: 5725: 5722: 5721: 5707: 5695: 5694: 5692: 5688: 5687: 5684: 5683: 5672: 5657: 5641: 5636: 5635: 5633: 5632:Classification 5623: 5622: 5619: 5618: 5616: 5615: 5610: 5608:Hemoperitoneum 5605: 5604: 5603: 5592: 5590: 5584: 5583: 5581: 5580: 5579: 5578: 5573: 5568: 5557: 5556: 5555: 5554: 5549: 5536: 5535: 5530: 5525: 5520: 5515: 5514: 5513: 5508: 5497: 5496: 5491: 5490: 5489: 5478: 5476: 5467: 5463: 5462: 5459: 5458: 5456: 5455: 5450: 5445: 5440: 5439: 5438: 5433: 5428: 5423: 5412: 5410: 5404: 5403: 5401: 5400: 5395: 5394: 5393: 5388: 5375: 5374: 5369: 5364: 5355: 5354: 5353: 5348: 5343: 5332: 5330: 5318: 5317: 5315: 5314: 5309: 5304: 5299: 5294: 5289: 5283: 5281: 5275: 5274: 5272: 5271: 5270: 5269: 5264: 5254: 5249: 5244: 5243: 5242: 5237: 5227: 5226: 5225: 5220: 5210: 5205: 5204: 5203: 5198: 5193: 5188: 5176: 5175: 5174: 5164: 5163: 5162: 5152: 5151: 5150: 5145: 5140: 5129: 5127: 5118: 5112: 5111: 5109: 5108: 5107: 5106: 5096: 5095: 5094: 5089: 5079: 5077:Blood in stool 5073: 5071: 5065: 5064: 5061: 5060: 5058: 5057: 5052: 5050:Anal dysplasia 5047: 5042: 5037: 5027: 5025: 5019: 5018: 5016: 5015: 5010: 5005: 5000: 4995: 4994: 4993: 4982: 4980: 4974: 4973: 4971: 4970: 4965: 4964: 4963: 4953: 4952: 4951: 4941: 4936: 4931: 4926: 4917: 4915:Angiodysplasia 4912: 4907: 4896: 4895: 4894: 4884: 4879: 4878: 4877: 4866: 4864: 4860: 4859: 4857: 4856: 4850:Diverticulosis 4846:Diverticulitis 4843: 4834: 4833: 4832: 4823: 4813: 4808: 4807: 4806: 4801: 4796: 4791: 4786: 4781: 4771: 4765: 4763: 4747: 4746: 4744: 4743: 4738: 4736:Milroy disease 4733: 4728: 4723: 4718: 4713: 4708: 4706:Tropical sprue 4703: 4694: 4693: 4692: 4682: 4681: 4680: 4675: 4670: 4659: 4657: 4634: 4628:Lower GI tract 4624: 4623: 4620: 4619: 4617: 4616: 4615: 4614: 4604: 4599: 4594: 4589: 4584: 4579: 4574: 4569: 4564: 4559: 4558: 4557: 4547: 4546: 4545: 4540: 4530: 4529: 4528: 4523: 4518: 4507: 4505: 4499: 4498: 4496: 4495: 4490: 4485: 4480: 4475: 4470: 4464: 4463: 4462: 4456: 4451: 4446: 4441: 4431: 4426: 4421: 4420: 4419: 4414: 4404: 4403: 4402: 4397: 4392: 4381: 4379: 4370: 4368:Upper GI tract 4364: 4363: 4357: 4355: 4354: 4347: 4340: 4332: 4326: 4325: 4286: 4280: 4272: 4271:External links 4269: 4266: 4265: 4216: 4189:(10): 1110–6. 4173: 4138: 4094: 4058: 4014: 3995:(4): 497–502. 3979: 3928: 3878: 3843: 3795: 3792:on 2006-10-26. 3760: 3717: 3710: 3692: 3685: 3667: 3660: 3642: 3591: 3556: 3507: 3458: 3402: 3373:(10): 1402–7. 3353: 3318: 3274: 3231: 3182: 3131: 3110:(3): 419–437. 3090: 3049: 3022:(8): 1475–81. 3005: 2986:(7): 1028–34. 2970: 2951:(6): 1637–44. 2935: 2897: 2861: 2812: 2763: 2742:(12): 2495–9. 2722: 2695:(6): 399–404. 2679: 2677: 2676: 2647: 2621:(11): 1141–4. 2608: 2607: 2570: 2541: 2512: 2486:(10): 577–82. 2475: 2449:(6): 399–404. 2430: 2378: 2324: 2283: 2274: 2222: 2179: 2152:(11): 3295–8. 2136: 2087: 2058:(3): 153–158. 2035: 2008:(6): 441–448. 1992: 1973: 1966: 1946: 1924: 1911:"Pancreatitis" 1902: 1864: 1863: 1861: 1858: 1857: 1856: 1851: 1844: 1841: 1823: 1820: 1815: 1814: 1811: 1808: 1805: 1802: 1794: 1791: 1790: 1789: 1786: 1783: 1780: 1777: 1774: 1771: 1768: 1759: 1756: 1746: 1745: 1742: 1738: 1737: 1734: 1730: 1729: 1726: 1722: 1721: 1718: 1714: 1713: 1710: 1699: 1698: 1695: 1692: 1688: 1687: 1684: 1681: 1677: 1676: 1673: 1670: 1666: 1665: 1662: 1659: 1655: 1654: 1651: 1648: 1644: 1643: 1640: 1637: 1620: 1617: 1616: 1615: 1612: 1599: 1595: 1592: 1582: 1579: 1574: 1559:Main article: 1556: 1553: 1543:Ranson's score 1539: 1536: 1528: 1527: 1524: 1521: 1518: 1515: 1512: 1507: 1504: 1503: 1502: 1499: 1496: 1493: 1490: 1485: 1482: 1474:Main article: 1471: 1468: 1467: 1466: 1462: 1461: 1419: 1416: 1415: 1414: 1407: 1402: 1401:Other measures 1399: 1398: 1397: 1394: 1391: 1388: 1381: 1380: 1377: 1368: 1365: 1361: 1360: 1357: 1340: 1337: 1328: 1325: 1320: 1317: 1297: 1294: 1265: 1262: 1232: 1229: 1216: 1213: 1208: 1205: 1185: 1182: 1174:cholelithiasis 1150: 1147: 1142: 1141: 1134: 1131: 1121: 1120: 1117: 1114: 1107: 1106: 1103: 1100: 1097: 1094: 1071: 1068: 1060: 1059: 1055: 1054: 1047: 1046: 1045: 1044: 1041: 1035: 1032: 1029: 1026: 1013: 1010: 1009: 1008: 1003: 997: 992: 986: 981: 970: 967: 966: 965: 961: 937: 934: 912: 911:Histopathology 909: 892: 889: 851: 848: 835: 832: 831: 830: 824: 815: 810: 805: 802: 793: 788: 783: 778: 776:bypass surgery 769: 764: 762:Scorpion venom 757: 754: 753: 752: 746: 741: 736: 730:choledochocele 726: 696: 678:mercaptopurine 626: 613: 610: 607: 600: 582: 579: 573: 564: 561: 559: 556: 555: 554: 553: 552: 549: 541: 540: 539: 529: 528: 527: 522: 517: 507: 506: 505: 499: 494: 491:encephalopathy 479: 478: 477: 472: 462: 461: 460: 457: 454: 446: 445: 444: 439: 434: 429: 420: 410: 409: 408: 406:Kidney failure 403: 395: 394: 393: 367: 366: 365: 303: 300: 299: 298: 294: 283: 276: 269: 262: 259: 253: 242: 239: 235: 234: 229: 224: 219: 213: 204: 198: 193: 188: 183: 178: 169: 166: 164: 161: 76: 75: 66: 60: 59: 52: 51: 43: 42: 39: 35: 34: 26: 24: 14: 13: 10: 9: 6: 4: 3: 2: 5768: 5757: 5754: 5752: 5751:Inflammations 5749: 5747: 5744: 5742: 5739: 5738: 5736: 5720: 5717: 5713: 5712: 5708: 5706: 5702: 5701: 5697: 5696: 5693: 5689: 5682: 5678: 5677: 5673: 5671: 5667: 5666: 5662: 5658: 5656: 5652: 5651: 5647: 5643: 5642: 5639: 5634: 5630: 5614: 5611: 5609: 5606: 5602: 5599: 5598: 5597: 5594: 5593: 5591: 5589: 5585: 5577: 5574: 5572: 5569: 5567: 5564: 5563: 5562: 5559: 5558: 5553: 5550: 5548: 5545: 5544: 5543: 5542: 5538: 5537: 5534: 5531: 5529: 5526: 5524: 5521: 5519: 5516: 5512: 5509: 5507: 5504: 5503: 5502: 5499: 5498: 5495: 5492: 5488: 5485: 5484: 5483: 5482:Diaphragmatic 5480: 5479: 5477: 5475: 5471: 5468: 5464: 5454: 5451: 5449: 5446: 5444: 5441: 5437: 5434: 5432: 5429: 5427: 5424: 5422: 5419: 5418: 5417: 5414: 5413: 5411: 5409: 5405: 5399: 5396: 5392: 5389: 5387: 5384: 5383: 5382: 5381: 5377: 5376: 5373: 5370: 5368: 5365: 5363: 5359: 5356: 5352: 5349: 5347: 5344: 5342: 5339: 5338: 5337: 5334: 5333: 5331: 5329: 5323: 5319: 5313: 5310: 5308: 5305: 5303: 5300: 5298: 5295: 5293: 5290: 5288: 5287:Cholecystitis 5285: 5284: 5282: 5280: 5276: 5268: 5265: 5263: 5260: 5259: 5258: 5255: 5253: 5250: 5248: 5245: 5241: 5238: 5236: 5233: 5232: 5231: 5230:Liver abscess 5228: 5224: 5221: 5219: 5216: 5215: 5214: 5213:Liver failure 5211: 5209: 5206: 5202: 5199: 5197: 5194: 5192: 5189: 5187: 5184: 5183: 5182: 5181: 5177: 5173: 5170: 5169: 5168: 5165: 5161: 5158: 5157: 5156: 5153: 5149: 5146: 5144: 5141: 5139: 5136: 5135: 5134: 5131: 5130: 5128: 5126: 5122: 5119: 5117: 5113: 5105: 5102: 5101: 5100: 5097: 5093: 5090: 5088: 5085: 5084: 5083: 5080: 5078: 5075: 5074: 5072: 5070: 5066: 5056: 5053: 5051: 5048: 5046: 5043: 5041: 5038: 5036: 5032: 5029: 5028: 5026: 5024: 5020: 5014: 5011: 5009: 5006: 5004: 5001: 4999: 4996: 4992: 4989: 4988: 4987: 4984: 4983: 4981: 4979: 4975: 4969: 4966: 4962: 4959: 4958: 4957: 4954: 4950: 4947: 4946: 4945: 4942: 4940: 4937: 4935: 4932: 4930: 4927: 4925: 4921: 4918: 4916: 4913: 4911: 4908: 4906: 4902: 4901: 4897: 4893: 4890: 4889: 4888: 4885: 4883: 4880: 4876: 4873: 4872: 4871: 4870:Enterocolitis 4868: 4867: 4865: 4861: 4855: 4851: 4847: 4844: 4842: 4838: 4835: 4831: 4827: 4824: 4822: 4819: 4818: 4817: 4814: 4812: 4809: 4805: 4802: 4800: 4797: 4795: 4792: 4790: 4787: 4785: 4782: 4780: 4777: 4776: 4775: 4772: 4770: 4767: 4766: 4764: 4761: 4757: 4752: 4748: 4742: 4739: 4737: 4734: 4732: 4729: 4727: 4724: 4722: 4719: 4717: 4714: 4712: 4709: 4707: 4704: 4702: 4698: 4697:Malabsorption 4695: 4691: 4688: 4687: 4686: 4683: 4679: 4676: 4674: 4671: 4669: 4666: 4665: 4664: 4661: 4660: 4658: 4655: 4651: 4647: 4642: 4638: 4635: 4633: 4629: 4625: 4613: 4610: 4609: 4608: 4605: 4603: 4600: 4598: 4595: 4593: 4590: 4588: 4585: 4583: 4580: 4578: 4575: 4573: 4572:Gastroparesis 4570: 4568: 4565: 4563: 4560: 4556: 4553: 4552: 4551: 4548: 4544: 4541: 4539: 4538:Cushing ulcer 4536: 4535: 4534: 4531: 4527: 4524: 4522: 4519: 4517: 4514: 4513: 4512: 4509: 4508: 4506: 4504: 4500: 4494: 4491: 4489: 4486: 4484: 4483:Megaesophagus 4481: 4479: 4476: 4474: 4471: 4468: 4465: 4460: 4457: 4455: 4452: 4450: 4447: 4445: 4442: 4440: 4437: 4436: 4435: 4432: 4430: 4427: 4425: 4422: 4418: 4415: 4413: 4410: 4409: 4408: 4405: 4401: 4398: 4396: 4393: 4391: 4388: 4387: 4386: 4383: 4382: 4380: 4378: 4374: 4371: 4369: 4365: 4361: 4353: 4348: 4346: 4341: 4339: 4334: 4333: 4330: 4322: 4318: 4314: 4309: 4304: 4300: 4296: 4292: 4287: 4284: 4281: 4279: 4275: 4274: 4270: 4261: 4257: 4252: 4247: 4243: 4239: 4235: 4231: 4227: 4220: 4217: 4212: 4208: 4204: 4200: 4196: 4192: 4188: 4184: 4177: 4174: 4169: 4165: 4161: 4157: 4153: 4149: 4142: 4139: 4134: 4130: 4126: 4122: 4118: 4114: 4110: 4106: 4098: 4095: 4090: 4086: 4082: 4078: 4074: 4070: 4062: 4059: 4054: 4050: 4046: 4042: 4038: 4034: 4031:(3): 238–42. 4030: 4026: 4023:evaluation". 4018: 4015: 4010: 4006: 4002: 3998: 3994: 3990: 3983: 3980: 3975: 3971: 3966: 3961: 3956: 3951: 3947: 3943: 3939: 3932: 3929: 3924: 3920: 3916: 3912: 3908: 3904: 3900: 3896: 3889: 3882: 3879: 3874: 3870: 3866: 3862: 3858: 3854: 3847: 3844: 3838: 3834: 3830: 3826: 3822: 3818: 3814: 3810: 3802: 3800: 3796: 3791: 3787: 3783: 3779: 3775: 3771: 3764: 3761: 3756: 3752: 3748: 3744: 3740: 3736: 3732: 3728: 3721: 3718: 3713: 3707: 3703: 3696: 3693: 3688: 3682: 3678: 3671: 3668: 3663: 3657: 3653: 3646: 3643: 3638: 3634: 3629: 3624: 3619: 3614: 3610: 3606: 3602: 3595: 3592: 3587: 3583: 3579: 3575: 3572:(6): 806–13. 3571: 3567: 3560: 3557: 3552: 3548: 3543: 3538: 3534: 3530: 3527:(3): 816–20. 3526: 3522: 3518: 3511: 3508: 3503: 3499: 3495: 3491: 3486: 3481: 3478:(3): 267–73. 3477: 3473: 3469: 3462: 3459: 3454: 3450: 3446: 3442: 3437: 3432: 3428: 3424: 3420: 3416: 3409: 3407: 3403: 3398: 3394: 3389: 3384: 3380: 3376: 3372: 3368: 3364: 3357: 3354: 3349: 3345: 3341: 3337: 3333: 3329: 3322: 3319: 3314: 3310: 3306: 3302: 3298: 3294: 3290: 3286: 3285:Pancreatology 3278: 3275: 3270: 3266: 3262: 3258: 3254: 3250: 3247:(6): 827–34. 3246: 3242: 3235: 3232: 3227: 3223: 3219: 3215: 3210: 3205: 3202:(2): 123–30. 3201: 3197: 3193: 3186: 3183: 3178: 3174: 3169: 3164: 3159: 3154: 3150: 3146: 3145:Pancreatology 3142: 3135: 3132: 3127: 3123: 3118: 3113: 3109: 3105: 3101: 3094: 3091: 3086: 3082: 3077: 3072: 3068: 3064: 3060: 3053: 3050: 3045: 3041: 3037: 3033: 3029: 3025: 3021: 3017: 3009: 3006: 3001: 2997: 2993: 2989: 2985: 2981: 2974: 2971: 2966: 2962: 2958: 2954: 2950: 2946: 2939: 2936: 2931: 2927: 2923: 2919: 2916:(5): 322–40. 2915: 2911: 2904: 2902: 2898: 2893: 2889: 2885: 2881: 2878:(5): 473–82. 2877: 2873: 2865: 2862: 2857: 2853: 2848: 2843: 2839: 2835: 2831: 2827: 2823: 2816: 2813: 2808: 2804: 2799: 2794: 2790: 2786: 2783:(2): 99–112. 2782: 2778: 2774: 2767: 2764: 2759: 2755: 2750: 2745: 2741: 2737: 2733: 2726: 2723: 2718: 2714: 2710: 2706: 2702: 2698: 2694: 2690: 2683: 2680: 2673: 2669: 2665: 2661: 2657: 2653: 2648: 2644: 2640: 2636: 2632: 2628: 2624: 2620: 2616: 2611: 2610: 2604: 2600: 2596: 2592: 2588: 2584: 2580: 2576: 2571: 2567: 2563: 2559: 2555: 2551: 2547: 2542: 2538: 2534: 2530: 2526: 2523:(5): 576–80. 2522: 2518: 2513: 2509: 2505: 2501: 2497: 2493: 2489: 2485: 2481: 2476: 2472: 2468: 2464: 2460: 2456: 2452: 2448: 2444: 2439: 2438: 2434: 2431: 2426: 2422: 2417: 2412: 2408: 2404: 2400: 2396: 2392: 2385: 2383: 2379: 2374: 2370: 2366: 2362: 2357: 2352: 2348: 2344: 2340: 2333: 2331: 2329: 2325: 2320: 2316: 2311: 2306: 2303:(5): 1361–6. 2302: 2298: 2294: 2287: 2284: 2278: 2275: 2270: 2266: 2262: 2258: 2253: 2248: 2244: 2240: 2236: 2229: 2227: 2223: 2218: 2214: 2210: 2206: 2202: 2198: 2194: 2190: 2183: 2180: 2175: 2171: 2167: 2163: 2159: 2155: 2151: 2147: 2140: 2137: 2132: 2128: 2123: 2118: 2114: 2110: 2106: 2102: 2098: 2091: 2088: 2083: 2079: 2074: 2069: 2065: 2061: 2057: 2053: 2049: 2042: 2040: 2036: 2031: 2027: 2023: 2019: 2015: 2011: 2007: 2003: 1996: 1993: 1988: 1984: 1977: 1974: 1969: 1963: 1959: 1958: 1950: 1947: 1934: 1928: 1925: 1913:. 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Retrieved 1927: 1915:. 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5167:Fatty liver 5087:Hematemesis 5069:GI bleeding 4875:Necrotizing 4804:Lymphocytic 4799:Collagenous 4794:Microscopic 4731:Steatorrhea 4632:Enteropathy 4478:Inlet patch 4400:Herpetiform 4385:Esophagitis 4301:(6): 1210. 2581:(1): 45–9. 1793:BISAP score 1598:<60 mmHg 1589:tachycardia 1585:Hypotension 1506:At 48 hours 1409:The use of 1327:Antibiotics 1274:dehydration 1270:intravenous 1012:Biochemical 977:Perforated 930:neutrophils 860:trypsinogen 756:Less common 686:salicylates 682:pentamidine 658:linagliptin 654:saxagliptin 650:sitagliptin 563:Most common 510:Hematologic 423:Hypovolemia 418:Arrhythmias 413:Circulatory 387:pneumonitis 379:atelectasis 370:Respiratory 273:epigastrium 227:peritonitis 216:tachycardia 207:hemodynamic 203:(shivering) 140:intravenous 105:alcohol use 38:Other names 5735:Categories 5676:DiseasesDB 5588:Peritoneal 5566:Incisional 5487:Congenital 5431:Hereditary 5408:Pancreatic 5372:Haemobilia 5045:Hemorrhoid 5023:Anal canal 4961:Infectious 4949:Functional 4784:Ulcerative 4668:Duodenitis 4607:Gastrinoma 3436:1874/26559 1917:14 October 1860:References 1833:gallstones 1650:Normal CT 1610:creatinine 1411:octreotide 1264:Bowel rest 1249:Meperidine 1184:Ultrasound 1043:Glycosuria 921:hemorrhage 917:parenchyma 796:Infections 638:furosemide 604:endoscopic 482:Neurologic 266:ecchymosis 5719:radio/521 5711:eMedicine 5576:Richter's 5533:Spigelian 5528:Obturator 5518:Umbilical 5351:Ascending 5322:Bile duct 5155:Cirrhosis 5133:Hepatitis 5116:Accessory 4986:Proctitis 4837:Megacolon 4811:Dysentery 4721:Whipple's 4673:Jejunitis 4663:Enteritis 4550:Dyspepsia 4511:Gastritis 4444:Achalasia 4377:Esophagus 4211:218906363 3853:Radiology 1939:4 October 1744:6 points 1736:4 points 1728:2 points 1720:0 points 1697:4 points 1686:3 points 1675:2 points 1653:0 points 1567:APACHE II 1561:APACHE II 1446:APACHE II 1207:Treatment 1000:Pleuritic 995:Pneumonia 936:Diagnosis 901:TNF-alpha 876:apoptosis 872:cathepsin 834:Pathology 791:Pregnancy 670:estrogens 634:thiazides 630:diuretics 616:Carcinoma 551:Arthalgia 502:Blindness 487:Psychosis 375:Hypoxemia 350:Metabolic 341:damage), 339:beta cell 121:recurrent 93:gallstone 64:Specialty 5716:med/1720 5506:Indirect 5501:Inguinal 5235:Pyogenic 5180:Vascular 4956:Diarrhea 4934:Volvulus 4900:Vascular 4839: / 4828: / 4789:Ischemic 4756:Appendix 4646:Duodenum 4516:Atrophic 4390:Candidal 4317:23852306 4260:15205290 4203:11099067 4168:16707751 4133:41655611 4125:19861954 4089:15380848 4053:24245362 4045:17895844 4025:Pancreas 4009:16183486 3974:16273623 3923:20809378 3915:16944038 3837:27166241 3829:12409825 3809:Pancreas 3786:16698595 3755:26047869 3637:18081218 3586:19217608 3551:18616944 3494:19125434 3453:11581054 3445:17573797 3348:23888429 3305:20110744 3261:22781906 3241:Pancreas 3226:38955726 3218:21243452 3177:24054878 3126:38857482 3085:36103415 3036:12924639 3000:18179795 2965:15547203 2930:18853839 2892:17363349 2807:24888393 2717:35768001 2709:15943725 2643:34932274 2635:11156345 2603:21285537 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