The most common etiologies of acute pancreatitis are gallstones (particularly 5 mm or smaller) and alcohol consumption. The serum amylase level may be normal in up to one-fifth of patients with acute pancreatitis; therefore, this level by itself is not a reliable diagnostic factor. The serum lipase level has a higher positive predictive value and specificity compared with the amylase level. Acute biliary pancreatitis with evidence of cholangitis represents an emergency indication for endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy within 24 hours of presentation. Early aggressive fluid rehydration with lactated Ringer solution and close monitoring within the first 12 to 24 hours may decrease risk of progression to systemic inflammatory response syndrome, prevent serious complications, improve morbidity, and decrease mortality from pancreatitis. Early enteral feeding reduces length of hospital stay, rate of infectious complications, and risks of morbidity and mortality. During a first hospitalization, laparoscopic cholecystectomy is recommended for patients with gallstone pancreatitis. Without cholecystectomy, approximately 20% to 30% of patients are readmitted within the next 90 days with a biliary condition or acute pancreatitis, sometimes severe. Early diagnosis and intervention in patients with chronic pancreatitis may prevent irreversible pancreatic damage.
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