Acute reaction to tissue necrosis from digestive enzymes released from exocrine pancreatic cells; affects up to 30/100 000.
Most common causes are alcoholic, bile stones or unknown. Less common causes are trauma, post-surgical, drugs (eg thiazide diuretics), hyperlipidaemia
Clinical features – sudden onset (sometimes gradual) with upper abdominal pain that can radiate to the back and distension, nausea, vomiting, sweat profusely patient is in great distress, as pain is often uncontrollable; sitting forward may relieve pain
Syncope, renal failure, hyperglycaemia and shock are common if severe
Laboratory – leucocytosis, elevated amylase and lipase, pancreatic enzymes in urine
Management – monitor patient’s vitals hourly; analgesics; correct any hypovolaemia