Core Topics in Critical Care Medicine

After gallstones, alcohol is the second most common cause of acute pancreatitis. The mechanism of alcohol-induced acute pancreatitis is incompletely understood, although some evidence points to increased sensitivity of acinar cell cholecystokinin receptors leading to increased release of trypsin. Patients typically present with pepigastric pain, often radiating to the back, accompanied by nausea and vomiting. On account of the wide spectrum of disease severity in acute pancreatitis there is particular interest in prognostic indicators that may help to determine the requirement for therapeutic interventions. A number of scoring systems such as Glasgow score, have been developed to attempt risk stratification in acute pancreatitis. The mainstay of treatment in severe acute pancreatitis is supportive care. The mortality associated with the first peak in the biphasic mortality curve is attributable to systemic inflammatory response and multiple organ failure. Full intensive care support may be necessary including ventilatory, cardiovascular and renal support.