Take Home Points
- Biliary sludge and microlithiasis are common causes of “idiopathic” acute pancreatitis.
- Gallbladder and biliary microlithiasis is usually missed on transcutaneous ultrasound.
- In the absence of any other etiology, biliary sludge/microlithiasis should be suspected as the cause in patients with acute pancreatitis and transient elevations in LFTs.
- There may be benefit to empiric endoscopic intervention (sphincterotomy/stenting) and/or cholecystectomy in these cases.
Complications of Acute Pancreatitis
Acute fluid collections: shortly after acute episode
Sterile pancreatic necrosis: shortly after acute episode – usually managed medically
Infected pancreatic fluid collection: within 1-3 weeks
Infected pancreatic necrosis: within 1-3 weeks
Acute pseudocyst (fluid collection walled off by granulation tissue): >4 weeks to develop
Infected pancreatic pseudocyst/abscess formation: 3-6 weeks
Common bile duct obstruction (2/2 pancreatic abscess, pseudocyst, biliary stone)
Hemorrhage 2/2 erosion of large vessels
Conditions associated with high serum lipase