الفهرس 
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Abstract
Acute pancreatitis is considered a common surgical emergency. It ranges from mild attack to severe acute pancreatitis up to pancreatic necrosis and multisystem organ failure.
As regards pathogenesis of acute pancreatitis: the principle mechanism for it is premature activation of the pancreatic enzymes within the pancrease that leads to organ injury and pancreatitis.
As regards diagnosis of acute pancreatitis a triple assessment should be followed:
1. Clinical diagnosis:
The patient with acute pancreatitis is presented mainly with upper abdominal pain, nausea and vomiting associated with multiple signs that may vary from mild tenderness to generalized peritonitis up to multisystem organ failure.
2. Laboratory diagnosis:
Serum amylase and lipase are the main diagnostic factors. However individual studies support the superiority of the lipase.
3. Imaging diagnosis :
Ultrasound, endoscopic ultrasound, computed, tomo-graphy and more recently MRI and MRCP.
Severity of acute pancreatitis can be assessed by:
1. Clinically.
2. Multifactorial systems:
It includes multiple scoring system for assessment of severity of acute pancreatitis like Ranson’s criteria, Glasgow criteria, APACHE scoring system , BALI scoring system and BISAP scoring system.
3. New serum markers:
These include IL-1, TNF, C. reactive protein, lactate dehydrogenase and others.
As regard management of acute pancreatitis it can be managed conservatively or surgically:
1 –Conservative management:
• It is reasonable to initiate antibiotic treatment only in patients with necrotizing pancreatitis.
• Nutritional support in acute pancreatitis: many studies had been shown that in patient with mild acute pancreatitis oral feeding should be started once the patient pain resolve. In patients with moderate to severe pancreatitis beginning nutritional support as early as possible is more beneficial.
• TPN may be required in patients who are unable to maintain their caloric needs with enteral nutrition . TPN should include fat emulsions in amounts sufficient to prevent essential fatty acid deficiency.
2- Surgical management:
The main indication for surgery in acute pancreatitis is infected pancreatic necrosis.
Timing of surgical intervention in acute necrotizing pancreatitis (ANP) has changed substantially during the last decade, from early necrosectomy to delayed operation in case of documented or suspected infection of pancreatic necrosis.
The therapeutic role of ERCP in acute pancreatitis is manifold. It is often directed towards management of gallstone and microlithiasis related pancreatitis, pancreas divisum, sphincter of Oddi dysfunction, pancreaticobiliary ascariasis, pancreatic ductal neoplasia or towards management of complications such as ductal disruption or debridement of pancreatic necrosis.
3-Other measures:
Other new measures in treatment of acute pancreatitis under research such as role of anticytokine therapy, low intensity laser radiation, protease inhibitors, antioxidant, heparin, H2 antagonist and role of Bee Honey.
As regard complications of acute pancreatitis it may be:
• Local, as pancreatic necrosis and pancreatic abscess.
• Systemic:
-Pulmonary,as pneumonia and pleural effusion.
-Cardiovascular,as hypotention and hypovolaemia.
-Haematologic as DIC.
-GIT, as haemorhage and peptic ulcer.
-Renal as oliguria.
-Metabolic, as hyperglycemia and hypocalcemia.
-CNS, as fat embolism and psychosis.
-Fat necrosis.
Prognosis of acute pancreatitis:
The overall mortality from acute pancreatitis has remained at 10-15% over the past 20 years. There is a clear responsibility before the patient is discharged to determine the aetiology of the attack of pancreatitis, and the causes must be looked for and excluded.