Pancreatitis

Last updated: April 8, 2026, 3:27 PM Pacific Time (PDT)
Disease framework for acute pancreatitis across common etiologies, including gallstone, hypertriglyceridemic, alcohol/drug/post-procedural, acalculous or non-biliary patterns, and severe necrotizing disease.
All Clinical risk factors Diagnostics Confirmation criteria Management Back to Main Page

Disease Pathway

risk factors -> diagnostics -> differential / confirmation -> etiology-based management
Clinical Risk Factors

Who should trigger pancreatitis reasoning?

  • Epigastric pain radiating to the back, nausea/vomiting, worsening after PO intake, or unexplained SIRS
  • Gallstones, biliary colic, cholestatic labs, recent ERCP, or prior pancreatitis
  • Heavy alcohol use, hypertriglyceridemia, diabetes/DKA, high-risk meds, trauma, or pancreatic malignancy
  • Shock, rising lactate, hypoxemia, AKI, ileus, or worsening abdominal exam should raise concern for severe disease
  • Acalculous or non-biliary pancreatitis should stay on the table when imaging lacks stones but the syndrome still fits
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Diagnostics

Order studies that confirm pancreatitis and help find the driver

Core labs
  • CBC
  • CMP
  • Lipase
  • Lactate
  • BUN / creatinine trend
Etiology labs
  • Triglycerides
  • LFTs
  • Direct bilirubin
  • Calcium
  • Blood gas
Imaging / diagnostics
  • RUQ ultrasound
  • CT abdomen / pelvis
  • MRCP
  • ECG
Procedures
  • ERCP
  • EUS
  • IR / surgical drainage if collection becomes infected or mature
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Differential Diagnosis

Keep other abdominal and biliary emergencies in play

Key mimics
  • Cholangitis / cholecystitis
  • Peptic ulcer disease / perforation
  • Mesenteric ischemia
  • Bowel obstruction
  • ACS or aortic pathology with upper abdominal pain
  • DKA / hypertriglyceridemic metabolic syndrome without pancreatitis
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Confirm Diagnosis

Use syndrome plus etiology clues

  • Acute pancreatitis: 2 of 3: typical pain, lipase or amylase >3x ULN, or imaging consistent with pancreatitis.
  • Gallstone / biliary pancreatitis: pancreatitis plus stones, cholestatic labs, ductal dilation, or strong biliary story.
  • Hypertriglyceridemic pancreatitis: pancreatitis with markedly elevated triglycerides, often with diabetes or DKA context.
  • Non-biliary / acalculous pancreatitis: pancreatitis without stone evidence, often alcohol-, medication-, post-ERCP-, ischemia-, or idiopathic-associated.
  • Severe or necrotizing pancreatitis: persistent organ dysfunction, infected necrosis concern, shock, respiratory failure, or worsening collections.
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Management

Select the working pancreatitis subtype

Current picture

Resident Pearls

Bedside Use

  • Most early management is supportive: fluids, analgesia, nausea control, and watching for organ failure.
  • Gallstone pancreatitis turns on whether there is persistent obstruction or cholangitis, not just whether stones exist.
  • CT is not always needed on day 1 if the diagnosis is already clear and the patient is not crashing.
  • Do not reach for antibiotics for uncomplicated pancreatitis; use them when there is cholangitis, another infection, or infected necrosis concern.
  • Hypertriglyceridemic pancreatitis should trigger aggressive metabolic thinking early, especially if DKA is also present.

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