353 Ch 352. Acute and Chronic Pancreatitis

Acute pancreatitis (AP) = acute inflammation; most common causes：(1) gallstones (50%, women)；(2) alcohol (25-30%, men)；(3) hypertriglyceridemia (> 1000 mg/dL)；(4) drugs；(5) ERCP (post-ERCP)；(6) trauma；(7) autoimmune；(8) idiopathic；(9) hypercalcemia；(10) genetic (PRSS1, SPINK1, CFTR)；diagnosis (2 of 3)：abdominal pain + lipase/amylase > 3x ULN + imaging consistent；severity：Atlanta Revised 2012 (mild, moderate, severe with organ failure)；mortality 1-30%；management：early aggressive IV fluid (LR preferred over NS — PAMPHLET trial) + analgesia + ERCP for gallstone with cholangitis/persistent obstruction + early nutrition (oral as tolerated > NJ tube > TPN)；chronic pancreatitis (CP)：irreversible parenchymal damage; alcohol most common; symptoms = chronic pain + exocrine insufficiency (steatorrhea + ADEK deficiency) + endocrine insufficiency (DM)；treatment：alcohol cessation + smoking cessation + pancreatic enzyme replacement therapy (PERT) + insulin + analgesia + procedure for refractory pain (ESWL, stenting, surgery)；2024 emerging：autoimmune pancreatitis recognition (IgG4-related vs Type 2), AI-assisted prediction。