Acute pancreatitis

The difficulty in differentiating between acute pancreatitis and other abdominal catastrophes is proven by the high incidence of diagnostic errors. It is most important to recognize perforations of peptic ulcers as immediate surgery is mandatory to good results. On the other hand, conservative treatment of acute pancreatitis gives a far lower mortality than that following early operative intervention. The determination of serum amylase levels has been a valuable addition to our diagnostic armamentarium as these rise sharply in the early stages of acute pancreatitis but are not increased in other acute abdominal conditions.The usual symptoms of acute pancreatitis are as follows: The history of acute abdominal pain varying in intensity and being most frequently located in the epigastrium and the right upper quadrant; tenderness and often rigidity in the area of the pain; nausea and vomiting invariably existing with shock accompanying severe attacks. There is often a history of previous milder attacks or of biliary colic. Jaundice is not infrequent. The leucocyte count is markedly elevated. Glycosuria and albuminuria frequently are found.Conservative therapy consists of relief of pain, rest in bed, continuous gastric rest and suction, adequate parenteral feedings to maintain blood chemistry and fluid balance, blood transfusions to overcome shock and careful observation. When the acute symptoms have subsided and the patient's condition has improved, biliary tract surgery should be contemplated if evidences of disease are found. Late drainage of pancreatic abscesses may be indicated.