eMedicine Specialties > Gastroenterology > Pancreas

Pancreatitis, Acute: Multimedia

Author: Timothy B Gardner, MD, Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of Pancreatic Disorders, Section of Gastroenterology, Dartmouth-Hitchcock Medical Center
Coauthor(s): Brian S Berk, MD, Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of End Stage Liver Disease, Section of Gastroenterology, Dartmouth Hitchcock Medical Center; Paul Yakshe, MD, Assistant Professor of Medicine, University of Minnesota, Medical Director of Pancreas and Biliary Clinic, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Fairview University Medical Center
Contributor Information and Disclosures

Updated: Jun 10, 2008

Multimedia

(Enlarge Image)

Media file 1: Suspected acute pancreatitis. Etiologic factors and forms of acute pancreatitis. Ranson criteria.

[ CLOSE WINDOW ]

Suspected acute pancreatitis. Etiologic factors and forms of acute pancreatitis. Ranson criteria.

(Enlarge Image)

Media file 2: Mild pancreatitis. Favorable prognostic signs for acute pancreatitis. Medical management and studies used for acute pancreatitis.

[ CLOSE WINDOW ]

Mild pancreatitis. Favorable prognostic signs for acute pancreatitis. Medical management and studies used for acute pancreatitis.

(Enlarge Image)

Media file 3: Prognostic indicators for severe pancreatitis and ICU management.

[ CLOSE WINDOW ]

Prognostic indicators for severe pancreatitis and ICU management.

(Enlarge Image)

Media file 4: Diagnosis and treatment of necrotizing pancreatitis.

[ CLOSE WINDOW ]

Diagnosis and treatment of necrotizing pancreatitis.

(Enlarge Image)

Media file 5: Treatment of and studies used for pancreatic pseudocysts.

[ CLOSE WINDOW ]

Treatment of and studies used for pancreatic pseudocysts.

(Enlarge Image)

Media file 6: Idiopathic recurrent pancreatitis. Etiologies for acute pancreatitis.

[ CLOSE WINDOW ]

Idiopathic recurrent pancreatitis. Etiologies for acute pancreatitis.

(Enlarge Image)

Media file 7: Pancreatic abscess. Definition of an abscess.

[ CLOSE WINDOW ]

Pancreatic abscess. Definition of an abscess.

(Enlarge Image)

Media file 8: This patient with acute gallstone pancreatitis underwent endoscopic retrograde cholangiopancreatography. The cholangiogram shows no stones in the common bile duct and multiple small stones in the gallbladder. The pancreatogram shows narrowing of the pancreatic duct in the area of the genu, the result of extrinsic compression of the ductal system by inflammatory changes in the pancreas.

[ CLOSE WINDOW ]

This patient with acute gallstone pancreatitis underwent endoscopic retrograde cholangiopancreatography. The cholangiogram shows no stones in the common bile duct and multiple small stones in the gallbladder. The pancreatogram shows narrowing of the pancreatic duct in the area of the genu, the result of extrinsic compression of the ductal system by inflammatory changes in the pancreas.

(Enlarge Image)

Media file 9: Abdominal CT scan showing pancreatic enlargement and peripancreatic fat stranding. The gallstones are not visible.

[ CLOSE WINDOW ]

Abdominal CT scan showing pancreatic enlargement and peripancreatic fat stranding. The gallstones are not visible.

(Enlarge Image)

Media file 10: Pancreas divisum associated with minor papilla stenosis causing recurrent pancreatitis. Because pancreas divisum is relatively common in the general population, it is best regarded as a variant of normal anatomy and not necessarily as a cause of pancreatitis. In this case, note the bulbous contour of the duct adjacent to the cannula. This appearance has been termed a Santorinicele. A dorsal duct outflow obstruction is the probable cause of pancreatitis when a Santorinicele is present and associated with a minor papilla that accommodates only a guidewire.

[ CLOSE WINDOW ]

Pancreas divisum associated with minor papilla stenosis causing recurrent pancreatitis. Because pancreas divisum is relatively common in the general population, it is best regarded as a variant of normal anatomy and not necessarily as a cause of pancreatitis. In this case, note the bulbous contour of the duct adjacent to the cannula. This appearance has been termed a Santorinicele. A dorsal duct outflow obstruction is the probable cause of pancreatitis when a Santorinicele is present and associated with a minor papilla that accommodates only a guidewire.

(Enlarge Image)

Media file 11: Normal-appearing ventral pancreas in a patient with recurrent acute pancreatitis. The dorsal pancreas (not pictured) showed evidence of chronic pancreatitis.

[ CLOSE WINDOW ]

Normal-appearing ventral pancreas in a patient with recurrent acute pancreatitis. The dorsal pancreas (not pictured) showed evidence of chronic pancreatitis.

(Enlarge Image)

Media file 12: CT scan of the abdomen in a child with traumatic pancreatitis. The fluid collection adjacent to the pancreas will become a pseudocyst. Note that the pancreas is lacerated, nearly cut in half, by the force of the abdominal trauma. Also, note the typical location of this injury in relation to the vertebral column.

[ CLOSE WINDOW ]

CT scan of the abdomen in a child with traumatic pancreatitis. The fluid collection adjacent to the pancreas will become a pseudocyst. Note that the pancreas is lacerated, nearly cut in half, by the force of the abdominal trauma. Also, note the typical location of this injury in relation to the vertebral column.

(Enlarge Image)

Media file 13: CT scan of a young man referred 2 weeks into his second bout of severe acute pancreatitis. He is gravely ill, with fever, leukocytosis, hypotension requiring pressors, and respiratory distress requiring mechanical ventilation. His abdominal CT scan shows severe acute pancreatitis. A percutaneous drain is placed in the dominant fluid collection to establish drainage while he is given imipenem/cilastatin and his condition is stabilized.

[ CLOSE WINDOW ]

CT scan of a young man referred 2 weeks into his second bout of severe acute pancreatitis. He is gravely ill, with fever, leukocytosis, hypotension requiring pressors, and respiratory distress requiring mechanical ventilation. His abdominal CT scan shows severe acute pancreatitis. A percutaneous drain is placed in the dominant fluid collection to establish drainage while he is given imipenem/cilastatin and his condition is stabilized.

(Enlarge Image)

Media file 14: Endoscopic retrograde cholangiopancreatography excluded suppurative cholangitis and established the presence of anular pancreas divisum. The dorsal pancreatogram showed extravasation into the retroperitoneum, and a sphincterotomy was performed on the minor papilla. As shown in this x-ray film, a pigtailed nasopancreatic tube was then inserted into the dorsal duct and out into the retroperitoneal fluid collection. The other end of the tube was attached to the bulb suction and monitored every shift.

[ CLOSE WINDOW ]

Endoscopic retrograde cholangiopancreatography excluded suppurative cholangitis and established the presence of anular pancreas divisum. The dorsal pancreatogram showed extravasation into the retroperitoneum, and a sphincterotomy was performed on the minor papilla. As shown in this x-ray film, a pigtailed nasopancreatic tube was then inserted into the dorsal duct and out into the retroperitoneal fluid collection. The other end of the tube was attached to the bulb suction and monitored every shift.

(Enlarge Image)

Media file 15: While percutaneous drains remove loculated fluid collections elsewhere in the abdomen, the nasopancreatic tube is containing the retroperitoneal fluid collection. One week later, the retroperitoneal fluid collection is much smaller as shown in this x-ray film (the image is reversed in the horizontal direction). By this time, the patient is off pressors and is ready to be extubated.

[ CLOSE WINDOW ]

While percutaneous drains remove loculated fluid collections elsewhere in the abdomen, the nasopancreatic tube is containing the retroperitoneal fluid collection. One week later, the retroperitoneal fluid collection is much smaller as shown in this x-ray film (the image is reversed in the horizontal direction). By this time, the patient is off pressors and is ready to be extubated.

(Enlarge Image)

Media file 16: Four months later, after the pseudocyst has been converted into a pseudocystogastrostomy using minimally invasive techniques, the pancreatogram reveals the more proximal pancreatic duct.

[ CLOSE WINDOW ]

Four months later, after the pseudocyst has been converted into a pseudocystogastrostomy using minimally invasive techniques, the pancreatogram reveals the more proximal pancreatic duct.

(Enlarge Image)

Media file 17: A guidewire is placed into the dorsal duct, crosses the stenotic area, and advances into the proximal duct. A dilating catheter is then advanced over the wire to enlarge the stenosis. The duct is subsequently stented.

[ CLOSE WINDOW ]

A guidewire is placed into the dorsal duct, crosses the stenotic area, and advances into the proximal duct. A dilating catheter is then advanced over the wire to enlarge the stenosis. The duct is subsequently stented.

(Enlarge Image)

Media file 18: Six months after severe acute pancreatitis, the patient remains symptom free, is living independently, and has been back at work for the past 3 years. As shown in this follow-up abdominal CT scan, minimally invasive techniques were successful in removing the pockets of infection, restoring the integrity of the pancreatic ductal system. They also preserved the endocrine function of the pancreas and, to date, this patient has no evidence of diabetes mellitus.

[ CLOSE WINDOW ]

Six months after severe acute pancreatitis, the patient remains symptom free, is living independently, and has been back at work for the past 3 years. As shown in this follow-up abdominal CT scan, minimally invasive techniques were successful in removing the pockets of infection, restoring the integrity of the pancreatic ductal system. They also preserved the endocrine function of the pancreas and, to date, this patient has no evidence of diabetes mellitus.

(Enlarge Image)

Media file 19: Familial adenomatous polyposis syndrome in a patient with persistent pancreatitis due to a partially obstructing ampullary adenoma. The pancreatogram shown here shows a very prominent ductal system. Because she has had several previous abdominal operations, she opted to undergo an endoscopic ampullectomy.

[ CLOSE WINDOW ]

Familial adenomatous polyposis syndrome in a patient with persistent pancreatitis due to a partially obstructing ampullary adenoma. The pancreatogram shown here shows a very prominent ductal system. Because she has had several previous abdominal operations, she opted to undergo an endoscopic ampullectomy.

(Enlarge Image)

Media file 20: As seen in this radiograph, stents were placed into the biliary and pancreatic ductal systems following ampullectomy. The smoldering pancreatitis resolved within a week, the stents were subsequently removed, and the patient is participating in an endoscopic surveillance program with no recurrence to date.

[ CLOSE WINDOW ]

As seen in this radiograph, stents were placed into the biliary and pancreatic ductal systems following ampullectomy. The smoldering pancreatitis resolved within a week, the stents were subsequently removed, and the patient is participating in an endoscopic surveillance program with no recurrence to date.

(Enlarge Image)

Media file 21: Recurrent pancreatitis associated with pancreas divisum in an elderly man. This pancreatogram of the dorsal duct shows a distal stenosis with upstream chronic pancreatitis. After the stenosis was dilated and stented, the pain resolved, and the patient improved clinically during one year of stent exchanges on a quarterly basis. Follow-up CT scans showed resolution of an inflammatory mass. Although ductal biopsies and cytology were repeatedly negative, pain and pancreatitis returned when the stents were removed. The patient developed duodenal outflow obstruction and was sent to surgery; a Whipple procedure revealed a periampullary adenocarcinoma (of the minor papilla).

[ CLOSE WINDOW ]

Recurrent pancreatitis associated with pancreas divisum in an elderly man. This pancreatogram of the dorsal duct shows a distal stenosis with upstream chronic pancreatitis. After the stenosis was dilated and stented, the pain resolved, and the patient improved clinically during one year of stent exchanges on a quarterly basis. Follow-up CT scans showed resolution of an inflammatory mass. Although ductal biopsies and cytology were repeatedly negative, pain and pancreatitis returned when the stents were removed. The patient developed duodenal outflow obstruction and was sent to surgery; a Whipple procedure revealed a periampullary adenocarcinoma (of the minor papilla).

(Enlarge Image)

Media file 22: X-ray film of patient initially seen for recurrent abdominal pain. An esophagogastroduodenoscopy showed a submucosal nodule in the antrum, which prompted a referral to another center requesting endoscopic ultrasound and polypectomy. Since the endoscopic ultrasonogram was indeterminate, a polypectomy was attempted. That evening, the patient developed progressively severe epigastric abdominal pain radiating to the back and presented to an emergency department. She had a leukocytosis and a mild elevation of her lipase and was admitted with a diagnosis of pancreatitis. This CT scan of her abdomen shows circumferential hypodense thickening of her antrum with a normal appearing pancreas. A small portion of pancreatic tissue was later identified as pancreatic rectitis in the pathology specimen.

[ CLOSE WINDOW ]

X-ray film of patient initially seen for recurrent abdominal pain. An esophagogastroduodenoscopy showed a submucosal nodule in the antrum, which prompted a referral to another center requesting endoscopic ultrasound and polypectomy. Since the endoscopic ultrasonogram was indeterminate, a polypectomy was attempted. That evening, the patient developed progressively severe epigastric abdominal pain radiating to the back and presented to an emergency department. She had a leukocytosis and a mild elevation of her lipase and was admitted with a diagnosis of pancreatitis. This CT scan of her abdomen shows circumferential hypodense thickening of her antrum with a normal appearing pancreas. A small portion of pancreatic tissue was later identified as pancreatic rectitis in the pathology specimen.

More on Pancreatitis, Acute

Overview: Pancreatitis, Acute

Differential Diagnoses & Workup: Pancreatitis, Acute

Treatment & Medication: Pancreatitis, Acute

Follow-up: Pancreatitis, Acute

Multimedia: Pancreatitis, Acute

References

« Previous Page

[ CLOSE WINDOW ]

References

Adams DB, Zellner JL, Anderson MC. Arterial hemorrhage complicating pancreatic pseudocysts: role of angiography. J Surg Res. Feb 1993;54(2):150-6. [Medline].
Ahearne PM, Baillie JM, Cotton PB, Baker ME, Meyers WC, Pappas TN. An endoscopic retrograde cholangiopancreatography (ERCP)-based algorithm for the management of pancreatic pseudocysts. Am J Surg. Jan 1992;163(1):111-5; discussion 115-6. [Medline].
Balthazar EJ, Ranson JH, Naidich DP, Megibow AJ, Caccavale R, Cooper MM. Acute pancreatitis: prognostic value of CT. Radiology. Sep 1985;156(3):767-72. [Medline].
Balthazar EJ, Robinson DL, Megibow AJ, Ranson JH. Acute pancreatitis: value of CT in establishing prognosis. Radiology. Feb 1990;174(2):331-6. [Medline].
Banks PA. Acute pancreatitis: conservative medical management. In: Buchler MW, Halter F, Uhl W, eds. Digestive Surgery. Vol 11. Farmington, Conn: Karger; 1994:220-25.
Banks PA, Freeman ML,. Practice guidelines in acute pancreatitis. Am J Gastroenterol. Oct 2006;101(10):2379-400. [Medline].
Beckingham IJ, Bornman PC. ABC of diseases of liver, pancreas, and biliary system. Acute pancreatitis. BMJ. Mar 10 2001;322(7286):595-8. [Medline].
Beger HG, Bittner R, Block S, Büchler M. Bacterial contamination of pancreatic necrosis. A prospective clinical study. Gastroenterology. Aug 1986;91(2):433-8. [Medline].
Berk JE. Management of acute pancreatitis: critical assessment. Keio J Med. Sep 1995;44(3):93. [Medline].
Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, Ga, September 11 through 13, 1992. Arch Surg. May 1993;128(5):586-90. [Medline].
Catalano MF, Geenen JE, Schmalz MJ. Pancreatic pseudocyst (PPC) treatment with pancreatic duct endoprosthesis. Gastrointest Endosc. 1994;40:102.
Chari ST, Smyrk TC, Levy MJ, Topazian MD, Takahashi N, Zhang L. Diagnosis of autoimmune pancreatitis: the Mayo Clinic experience. Clin Gastroenterol Hepatol. Aug 2006;4(8):1010-6; quiz 934. [Medline].
Cremer M, Deviere J, Engelholm L. Endoscopic management of cysts and pseudocysts in chronic pancreatitis: long-term follow-up after 7 years of experience. Gastrointest Endosc. Jan-Feb 1989;35(1):1-9. [Medline].
Domínguez-Munoz JE, Carballo F, García MJ, Miguel de Diego J, Gea F, Yangüela J, et al. Monitoring of serum proteinase--antiproteinase balance and systemic inflammatory response in prognostic evaluation of acute pancreatitis. Results of a prospective multicenter study. Dig Dis Sci. Mar 1993;38(3):507-13. [Medline].
Eatock FC, Chong P, Menezes N, Murray L, McKay CJ, Carter CR. A randomized study of early nasogastric versus nasojejunal feeding in severe acute pancreatitis. Am J Gastroenterol. Feb 2005;100(2):432-9. [Medline].
Fan ST, Lai EC, Mok FP, Lo CM, Zheng SS, Wong J. Early treatment of acute biliary pancreatitis by endoscopic papillotomy. N Engl J Med. Jan 28 1993;328(4):228-32. [Medline].
Gan SI, Romagnuolo J. Admission hematocrit: a simple, useful and early predictor of severe pancreatitis. Dig Dis Sci. Nov-Dec 2004;49(11-12):1946-52. [Medline].
Goldstein F, Kucer FT, Thornton JJ 3rd, Abramson J. Acute and relapsing pancreatitis caused by bile pigment aggregates and diagnosed by biliary drainage. Am J Gastroenterol. Sep 1980;74(3):225-30. [Medline].
Grace PA, Williamson RC. Modern management of pancreatic pseudocysts. Br J Surg. May 1993;80(5):573-81. [Medline].
Guelrud M, Siegel JH. Hypertensive pancreatic duct sphincter as a cause of pancreatitis. Successful treatment with hydrostatic balloon dilatation. Dig Dis Sci. Mar 1984;29(3):225-31. [Medline].
Havala T, Shronts E, Cerra F. Nutritional support in acute pancreatitis. Gastroenterol Clin North Am. Sep 1989;18(3):525-42. [Medline].
Imrie CW. Indications for surgery in acute pancreatitis. Dig Surg. 1994;11:242-4.
Jacobson E, Assareh H, Cannerfelt R, Anderson RE, Jakobsson JG. The postoperative analgesic effects of intra-articular levobupivacaine in elective day-case arthroscopy of the knee: a prospective, randomized, double-blind clinical study. Knee Surg Sports Traumatol Arthrosc. Feb 2006;14(2):120-4. [Medline].
Karjalainen J, Airo I, Nordback I. Routine early endoscopic cholangiography, sphincterotomy and removal of common duct stones in acute gallstone pancreatitis. Eur J Surg. Oct 1992;158(10):549-53. [Medline].
Kelly TR, Wagner DS. Gallstone pancreatitis: a prospective randomized trial of the timing of surgery. Surgery. Oct 1988;104(4):600-5. [Medline].
Khan Z, Vlodov J, Horovitz J, Jose RM, Iswara K, Smotkin J. Urinary trypsinogen activation peptide is more accurate than hematocrit in determining severity in patients with acute pancreatitis: a prospective study. Am J Gastroenterol. Aug 2002;97(8):1973-7. [Medline].
Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. Oct 1985;13(10):818-29. [Medline].
Kozarek RA, Ball TJ, Patterson DJ, Freeny PC, Ryan JA, Traverso LW. Endoscopic transpapillary therapy for disrupted pancreatic duct and peripancreatic fluid collections. Gastroenterology. May 1991;100(5 Pt 1):1362-70. [Medline].
Lankisch PG, Mahlke R, Blum T, Bruns A, Bruns D, Maisonneuve P. Hemoconcentration: an early marker of severe and/or necrotizing pancreatitis? A critical appraisal. Am J Gastroenterol. Jul 2001;96(7):2081-5. [Medline].
Lee SP, Nicholls JF, Park HZ. Biliary sludge as a cause of acute pancreatitis. N Engl J Med. Feb 27 1992;326(9):589-93. [Medline].
Lumsden A, Bradley EL 3rd. Secondary pancreatic infections. Surg Gynecol Obstet. May 1990;170(5):459-67. [Medline].
Malfertheiner P, Dominguez-Munoz JE. Diagnosis and staging of acute pancreatitis. Dig Surg. 1994;11:198-208.
Mann DV, Hershman MJ, Hittinger R, Glazer G. Multicentre audit of death from acute pancreatitis. Br J Surg. Jun 1994;81(6):890-3. [Medline].
Nathens AB, Curtis JR, Beale RJ, Cook DJ, Moreno RP, Romand JA. Executive summary: management of the critically ill patient with severe acute pancreatitis. Proc Am Thorac Soc. 2004;1(4):289-90. [Medline].
National Center for Health Statistics. National hospital discharge survey: 2002 annual summary with detailed diagnosis and procedure data. Series Report 13. 2003;No. 158 (PHS 2005-1729):207.
Neoptolemos JP, Carr-Locke DL, London NJ, Bailey IA, James D, Fossard DP. Controlled trial of urgent endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy versus conservative treatment for acute pancreatitis due to gallstones. Lancet. Oct 29 1988;2(8618):979-83. [Medline].
Neoptolemos JP, Davidson BR, Winder AF, Vallance D. Role of duodenal bile crystal analysis in the investigation of 'idiopathic' pancreatitis. Br J Surg. May 1988;75(5):450-3. [Medline].
Neoptolemos JP, Raraty M, Finch M. Acute pancreatitis: the substantial human and financial costs. Gut. 1988;42(6):886-91.
Okazaki K, Yamamoto Y, Ito K. Endoscopic measurement of papillary sphincter zone and pancreatic main ductal pressure in patients with chronic pancreatitis. Gastroenterology. Aug 1986;91(2):409-18. [Medline].
Pandol SJ, Saluja AK, Imrie CW, Banks PA. Acute pancreatitis: bench to the bedside. Gastroenterology. Mar 2007;132(3):1127-51. [Medline].
Pinkas H, Dolan RP, Brady PG. Successful endoscopic transpapillary drainage of an infected pancreatic pseudocyst. Gastrointest Endosc. Jan-Feb 1994;40(1):97-9. [Medline].
Pisters PW, Ranson JH. Nutritional support for acute pancreatitis. Surg Gynecol Obstet. Sep 1992;175(3):275-84. [Medline].
Ranson J H. Acute pancreatitis. In: Braasch JW, ed. Surgical Disease of the Biliary Tract and Pancreas. St. Louis, Mo: Mosby; 1994:432-72.
Ranson JH. The timing of biliary surgery in acute pancreatitis. Ann Surg. May 1979;189(5):654-63. [Medline].
Ranson JH, Rifkind KM, Turner JW. Prognostic signs and nonoperative peritoneal lavage in acute pancreatitis. Surg Gynecol Obstet. Aug 1976;143(2):209-19. [Medline].
Ros E, Navarro S, Bru C, Garcia-Pugés A, Valderrama R. Occult microlithiasis in 'idiopathic' acute pancreatitis: prevention of relapses by cholecystectomy or ursodeoxycholic acid therapy. Gastroenterology. Dec 1991;101(6):1701-9. [Medline].
Rossi R L, Tsao J I. Chronic pancreatitis: complications. In: Surgical Disease of the Biliary Tract and Pancreas. St. Louis, Mo: Mosby-Year Book; 1994:490-504.
Sacks D, Robinson ML. Transgastric percutaneous drainage of pancreatic pseudocysts. AJR Am J Roentgenol. Aug 1988;151(2):303-6. [Medline].
Sahel J. Endoscopic drainage of pancreatic cysts. Endoscopy. May 1991;23(3):181-4. [Medline].
Sarr MG. Planned reoperative necrosectomy/debridement of necrotizing acute pancreatitis and delayed primary closure. Dig Surg. 1994;11:252-6.
Schwesinger WH, Page CP, Sirinek KR, Levine BA, Aust JB. Biliary pancreatitis. Operative outcome with a selective approach. Arch Surg. Jul 1991;126(7):836-9; discussion 839-40. [Medline].
Segal I. Controversies in the management of pancreatic pseudocysts: alternative therapies to surgery. Gastroenterologist. Mar 1993;1(1):34-8. [Medline].
Smits ME. Endoscopic drainage of pancreatic pseudocysts. Gastrointest Endosc. 1994;40:127.
Stanten R, Frey CF. Comprehensive management of acute necrotizing pancreatitis and pancreatic abscess. Arch Surg. Oct 1990;125(10):1269-74; discussion 1274-5. [Medline].
Stelzner M, Pellegrini C. The treatment of gallstone pancreatitis. Adv Surg. 1999;33:163-79. [Medline].
Stoupis C, Becker C, Vock P. Imaging procedures in acute pancreatitis. Dig Surg. 1994;11:209-13.
Toouli J, Roberts-Thomson IC, Dent J, Lee J. Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis. Br J Surg. Nov 1985;72(11):859-63. [Medline].
Traverson LW. Infections complicating severe pancreatitis. Infec Dis Clin North Am. 1992;6:601-11.
Uhl W, Schrag HJ, Buchler MW. Acute pancreatitis: Necrosectomy and closed continuous lavage of the retroperitoneum. Dig Surg. 1994;11:245-51.
Whitcomb DC. Clinical practice. Acute pancreatitis. N Engl J Med. May 18 2006;354(20):2142-50. [Medline].

[ CLOSE WINDOW ]

Keywords

pancreas, pancreatic enzymes, pancreastasis, pancreatic autodigestion, abdominal pain, elevated pancreatic enzyme levels, inflammation of the pancreas, endoscopic retrograde cholangiopancreatography, ERCP, magnetic resonance cholangiopancreatography, MRCP, endoscopic ultrasound, zymogen granules, alcohol abuse, alcohol dependence, alcoholism, alcoholics, biliary disease, biliary tract disease

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Timothy B Gardner, MD, Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of Pancreatic Disorders, Section of Gastroenterology, Dartmouth-Hitchcock Medical Center
Timothy B Gardner, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Medical Association, American Pancreatic Association, and American Society of Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Coauthor(s)

Brian S Berk, MD, Assistant Professor, Department of Medicine, Dartmouth Medical School; Director of End Stage Liver Disease, Section of Gastroenterology, Dartmouth Hitchcock Medical Center
Brian S Berk, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, and American Gastroenterological Association
Disclosure: Nothing to disclose.

Paul Yakshe, MD, Assistant Professor of Medicine, University of Minnesota, Medical Director of Pancreas and Biliary Clinic, Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, Fairview University Medical Center
Paul Yakshe, MD is a member of the following medical societies: American College of Gastroenterology, American Pancreatic Association, and American Society for Gastrointestinal Endoscopy
Disclosure: Nothing to disclose.

Medical Editor

Tushar Patel, MB, ChB, Professor of Medicine, Director of Hepatology, Ohio State University Medical Center
Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada
Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

Search for CME/CE on This Topic »

CLOSE [X]
SPECIALTY SITES Allergy & Clinical Immunology Anesthesiology Cardiology Critical Care Dermatology Diabetes & Endocrinology Emergency Medicine Family Medicine Gastroenterology General Surgery Hematology-Oncology HIV/AIDS Infectious Diseases	Internal Medicine Lab Medicine Nephrology Neurology Ob/Gyn & Women's Health Oncology Ophthalmology Orthopaedics Pathology & Lab Medicine Pediatrics Plastic Surgery & Aesthetic Medicine Psychiatry & Mental Health Public Health & Prevention Pulmonary Medicine	Radiology Rheumatology Surgery Transplantation Urology Women's Health OTHER SITES Business of Medicine Medscape Today Med Students Nurses Pharmacists

eMedicine Specialties > Gastroenterology > Pancreas

Pancreatitis, Acute: Multimedia

Multimedia

Suspected acute pancreatitis. Etiologic factors and forms of acute pancreatitis. Ranson criteria.

Mild pancreatitis. Favorable prognostic signs for acute pancreatitis. Medical management and studies used for acute pancreatitis.

Prognostic indicators for severe pancreatitis and ICU management.

Diagnosis and treatment of necrotizing pancreatitis.

Treatment of and studies used for pancreatic pseudocysts.

Idiopathic recurrent pancreatitis. Etiologies for acute pancreatitis.

Pancreatic abscess. Definition of an abscess.

Abdominal CT scan showing pancreatic enlargement and peripancreatic fat stranding. The gallstones are not visible.

Normal-appearing ventral pancreas in a patient with recurrent acute pancreatitis. The dorsal pancreas (not pictured) showed evidence of chronic pancreatitis.

Four months later, after the pseudocyst has been converted into a pseudocystogastrostomy using minimally invasive techniques, the pancreatogram reveals the more proximal pancreatic duct.

A guidewire is placed into the dorsal duct, crosses the stenotic area, and advances into the proximal duct. A dilating catheter is then advanced over the wire to enlarge the stenosis. The duct is subsequently stented.

More on Pancreatitis, Acute

References

Further Reading

Keywords

Contributor Information and Disclosures

Author

Coauthor(s)

Medical Editor

Pharmacy Editor

Managing Editor

CME Editor

Chief Editor