Phases of acute pancreatitis

Phases of acute pancreatitis

Two overlapping phases with two peaks of mortality can be identified in acute pancreatitis:

• early phase
  • present during the first week (but may extend to the second week as well)
    
    
  • host response to local pancreatic injury will result in systemic disturbances which will clinically manifest as the systemic inflammatory response syndrome (SIRS)
    • SIRS - defined by presence of two or more criteria:
      • heart rate >90 beats/min
      • core temperature <36°C or >38°C
      • white blood count <4000 or >12000/mm3
      • respirations >20/min or PCO2 <32mmHg
        
        
  • the severity of acute pancreatitis during early phase is determined by the presence and duration of organ failure
    • persistent SIRS (>48 hours) has been shown to be strongly associated with subsequent risk of developing organ failure
      
      
  • local complications may be present but does not influence the severity of the condition
    
    
• late phase
  • characterised by the continuation of systemic signs of inflammation or by the presence of local complications
  • seen only in patients with moderately severe or severe acute pancreatitis (1,2)

Reference:

1. Banks PA et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102-11.
2. Johnson CD, Besselink MG, Carter R. Acute pancreatitis. BMJ. 2014;349:g4859