Pancreatic Diseases

Acute pancreatitis is a common cause of hospitalization worldwide. The disease can range in severity from mild to severe with the latter associated with significant morbidity and mortality. The most common causes are gallstones and alcohol. The diagnosis can be made based on the presence of characteristic abdominal pain and elevated levels of amylase and/or lipase. Early imaging is only indicated if the diagnosis is uncertain or if there is a need to rule out other serious conditions. Risk stratification and prediction models can identify patients who are at higher risk for severe disease and increased mortality. Treatment focuses on fluid resuscitation, with recent data suggesting a goal-directed moderate rate of resuscitation is safest. Early oral feeding as tolerated and analgesia should be offered. Chronic pancreatitis is a disorder of progressive inflammation and irreversible fibrosis characterized by abdominal pain and exocrine and endocrine insufficiency. Management involves support of pancreatic impairment and control of symptoms with medications, endoscopic therapy, and/or surgery. Pancreatic cystic neoplasms are a group of neoplastic cysts that are often detected incidentally on imaging. The clinical course ranges from benign to malignant disease. Accurate diagnosis is important for determining the potential for malignancy and guiding treatment decisions.