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When considering the diagnosis of AP, emergency room clinicians should order basic laboratory which including complete blood count, lipase, amylase, liver function tests, blood urea nitrogen, creatinine, LDH, and triglycerides.

Gallstones and alcohol are the two most common causes of AP. Gallstones are estimated as culprit in 40–70% of cases [14]. Therefore, a transabdominal ultrasound should be obtained in all patients presenting with AP to the emergency room [15]. However, if the patient has normal liver function tests at the time of diagnosis of AP and has gallstones, the gallstones may not be the cause of AP as evidenced by recurrence of AP in approximately 34% of cases after cholecystectomy [16]. Alcohol intake is the second most common cause, noted in 25–40% of patients [14,17]. For alcohol to cause AP, it is considered that the patient should have a history of chronic alcohol abuse, consuming more than 50 g of alcohol per day for more than five years. Binge drinking in such patients can cause AP after an interval from cessation of drinking [18,19]. However, it should be noted that only a small proportion of such heavy drinkers (<5%) will develop pancreatitis. The presence of an abnormality in the gene for claudin‐2 (CLDN2) may explain those who might suffer pancreatic disease [20]. A thorough alcohol history should be obtained in all patients presenting with AP.

In absence of gallstones or significant alcohol intake, other less common causes should be considered. Hypertriglyceridemia (triglyceride levels >1000 mg/dl) can cause AP [21]. Patients who have undergone recent ERCP could develop acute post‐ERCP pancreatitis as an adverse event from the procedure [22,23]. Many medications have been hypothesized to cause pancreatitis. Some of the well‐known culprits are 6‐mercaptopurine or azathioprine, L‐asparaginase, isoniazid, loop diuretics, and didanosine [24]. Rarely, pancreatic neoplasm or cysts (intraductal papillary mucinous neoplasm) can present as AP. If no obvious etiology is found after initial work‐up with blood tests and transabdominal ultrasound, further work should be done by seeking expert consultation.