Acute inflammatory process of pancreas with variable involvement of other local tissues and remote organs

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  Interstitial edematous pancreatitis, necrotizing pancreatitis

  
  
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  Acute pancreatic fluid collection ± infection

  
  
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  Acute necrotic collection ± infection

Focal or diffuse enlargement of pancreas

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  In mild pancreatitis, sonographic signs may be subtle or normal

Blurred pancreatic outline/margin: Pancreatic edema and peripancreatic exudate

Heterogeneous echotexture due to intrapancreatic necrosis or hemorrhage

Collections: Anechoic peripancreatic fluid; fluid within pancreatic parenchyma or containing debris

Presence of gas suggests infection/bowel fistula unless secondary to interventional procedure

CECT best in late phase to delineate extent of inflammation and detect necrosis and complications

MR best to detect choledocholithiasis or in patients who cannot undergo CECT

Color Doppler to evaluate for vascular complications: Venous thrombosis, arterial pseudoaneurysms

Infiltrating pancreatic carcinoma

Lymphoma and metastases

Autoimmune pancreatitis

Perforated duodenal ulcer

“Shock” pancreas

Interstitial edematous pancreatitis or acute hemorrhagic pancreatitis

Usually young and middle-aged groups, M > F

Acute-onset epigastric pain, often radiating to back

Tenderness, fever, nausea, vomiting, ↑ amylase/lipase

Risk factors: Alcohol, gallstones, metabolic, infection, trauma, drugs, ERCP

Hereditary pancreatitis or congenital ductal anomalies

Diagnosis based on presence of at least 2 out of 3 of following: Abdominal pain consistent with pancreatitis, lipase or amylase level > 3x upper limit of normal, imaging findings consistent with acute pancreatitis

Hyperglycemia, increased lactate dehydrogenase, leukocytosis, hypocalcemia, fall in hematocrit, rise in blood urea nitrogen

Revised Atlanta classification of acute pancreatitis: Early phase < 1 week, late phase > 1 week

Ultrasound most useful to rule out cholelithiasis in acute pancreatitis