Acute Pancreatitis

A patient with abrupt, severe epigastric pain radiating to the back and a lipase four times the laboratory upper limit of normal already meets two diagnostic criteria for acute pancreatitis. The next best move is usually not an immediate CT; it is to assess perfusion and organ function, identify the cause, and begin moderate, goal-directed fluid therapy. That sequence matters because acute pancreatitis can begin as a local pancreatic injury and progress to systemic inflammation, capillary leak, intravascular depletion and organ failure. The diagnostic rule establishes the disease. It does not establish its severity or tell you whether the cause is gallstones, alcohol, hypertriglyceridaemia, a medication or another process.