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All patients with AP must undergo a diagnostic work‐up to find the cause of the pancreatitis. Figure 2.1 shows an algorithmic approach for investigating a patient with AP. Careful history of alcoholism, smoking, medications, family history of pancreatitis, and basic investigations including abdominal USG, and serum calcium and triglyceride levels are essential for initial work‐up. In patients without an identifiable cause, EUS and MRCP should be performed to establish the etiological diagnosis. A repeat evaluation after three to six months of negative work‐up may reveal a cause (e.g. gallstones and occult tumor). A patient with truly idiopathic AP should be advised follow‐up because he or she is at risk of recurrence and may even develop chronic pancreatitis in the long term and thus requires periodic careful assessment.

Figure 2.1 Investigative work‐up and treatment for patients with acute pancreatitis to prevent recurrence. CBD, common bile duct; EUS, endoscopic ultrasound; LFT, liver function test; MRCP, magnetic resonance cholangiopancreatography; RAP, recurrent acute pancreatitis.

Source: adapted from Jagannath and Garg [69]. Reproduced with permission of Springer Nature.