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Acute pancreatitis (AP) is an acute inflammatory condition of the pancreas with significant morbidity and mortality. Global incidence of AP is 34 per 100 000 person‐years with a mortality of 1.6 per 100 000 person‐years [1]. Most cases of AP are mild but severe pancreatitis occurs in 10–20% of patients, who present with organ failure with a high mortality of up to 40% [2,3]. Around 25% of patients with AP develop recurrence of pancreatitis and a variable proportion of them progress to chronic pancreatitis over time [4].

AP occurs due to a variety of causes. Making the etiological diagnosis of AP is important and possible in most cases. Two of the most common causes of AP are biliary (40–70%) and alcohol (25–35%) [3,5,6]. Other causes of AP are enumerated in Table 2.1. Although the etiology has no major bearing on outcome of AP [7], its determination is important to prevent the recurrence and progression to chronic pancreatitis since most of the causes are either modifiable or treatable. The annual rate of relapse after first attack of AP is 5.3 per 100 per year in patients with alcoholic etiology and 1.5 per 100 per year in those with biliary etiology [5]. Hence, identification of the etiology dictates further management after the acute episode resolves. In this chapter we discuss the various causes of AP (Table 2.1) and a diagnostic algorithm for etiological diagnosis of AP.