Key messages

• Early differentiation between edematous (90 per cent) and necrotizing (10 per cent) pancreatitis is important for both prognostication and therapeutic strategy.

• Clear-cut identification of an etiological factor impacts on therapy, prognosis, and prevention of recurrences. Alcohol abuse and biliary stones or sludge account for more than 85 per cent of episodes.

• Abdominal pain, vomiting, and hyperamylasemia are diagnostic cornerstones, and CT is the imaging method of choice for diagnostic dilemmas.

• Both severity and prognosis depend on the magnitude of the inflammatory reaction initiated in the retroperitoneal space, the presence and extent of regional necrosis, and any subsequent bacterial contamination.

• Multisystem organ dysfunction syndrome typically complicates the early phases and is best ascribed to spillage of inflammatory mediators, activated enzymes, and vasoactive substances from the retroperitoneal areas into the systemic circulation.

• Mortality associated with severe acute pancreatitis still ranges between 10 and 20 per cent.

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