Diagnosis and management of acute pancreatitis

Acute pancreatitis usually occurs as a result of alcohol abuse or bile duct obstruction. A careful review of the patient's history and appropriate lab oratory studies can help the physician identify the etiology of the conditi on and guide management. Serum amylase and lipase levels are still used to confirm the diagnosis of acute pancreatitis. Although not routinely availab le, the serum trypsin level is the most accurate laboratory indicator for p ancreatitis. Ultrasonography, computed tomography and endoscopic retrograde cholangiopancreatography are additional modalities that can help the famil y physician choose the best treatment approach. Prompt identification of pa tients who need intensive care referral or subspecialty consultation is cru cial. The APACHE II and the multiple organ system failure scales provide pr ognostic information at the time of admission and may be repeated daily to monitor disease progression. Therapies such as nasogastric suctioning. anti cholinergics and histamine H-2-receptor blockers have not been shown to dec rease symptoms or hospital stays in patients with acute pancreatitis, Syste mic antibiotics have been found to improve outcome in patients with severe disease. With supportive care, most patients have a good clinical outcome.