The spectrum of
acute pancreatitis can range from mild and self-limited to severe and fatal. A number of aspects of the condition remain poorly understood or controversial, although recent advances have improved our understanding in many areas. A substantial number of cases of "idiopathic"
acute pancreatitis may be caused by occult biliary microlithiasis. The mechanism by which
enzymes and bioactive substances become activated within the pancreas is a major unanswered question in
acute pancreatitis; however, recent studies suggest that lysosomal
enzymes within the pancreatic acinar cell may play a role. A recent refinement in computed tomography, contrast-enhanced dynamic pancreatography, has shown itself to be an extremely useful tool for detecting
pancreatic necrosis and its extent, which correlates with the severity of
pancreatitis and is useful in identifying patients who may have pancreatic
infection and other complications. The management of
acute pancreatitis includes supportive measures, observation for development of complications, and the identification of the cause of
pancreatitis to prevent recurrences. Specific treatments introduced with the goal of halting the cycle of pancreatic autodigestion and benefiting the course of
pancreatitis have generally proved ineffective. Early aggressive treatment of biliary
pancreatitis remains controversial; however,
endoscopic sphincterotomy may be helpful in more severe cases of biliary
pancreatitis if there is no clinical improvement over 48 to 72 hours. Computed tomography-guided percutaneous needle aspiration appears to be a safe and reliable method for diagnosing infected
pancreatic necrosis, pancreatic
abscess, and infected pancreatic fluid collections.