Problems in the diagnosis and management of acute pancreatitis

Despite the lack of precise knowledge as to its exact mechanism of causation, acute pancreatitis continues to engage the clinician's attention. The world medical literature is replete with publications on the subject and the numerous Australian studies attest to the continuing clinical interest (Hennessy, 1965; Bennett and Jepson, 1966; Kune, 1968; Barraclough and Coupland, 1972; Battersby and Chapuis, 1977 and Reid and Kune, 1978). The majority of these reviews concentrate on the supposed aetiology and clinical features of acute pancreatitis and cover well trodden ground. It is the purpose of this paper to review the problems in the diagnosis and management of acute pancreatitis in the light of present knowledge and to relate these to 494 patients with acute pancreatitis admitted to St Vincent's Hospital, Melbourne, during the period 1968 to 1979. The diagnosis of acute pancreatitis in these 494 cases was made at operation, autopsy or by the demonstration of an elevation in the serum amylase above 1200 International units (I.U.) per litre in patients with compatible symptoms and signs.