1;Foreword;6 2;Preface;7 3;Table of Contents;9 4;Acute Pancreatitis;11 4.1;1 Pathophysiology of Acute Pancreatitis;12 4.1.1;1.1 Introduction;12 4.1.2;1.2 Etiology;12 4.1.2.1;1.2.1 Mechanical Etiology;13 4.1.2.1.1;1.2.1.1 Biliary Calculi;13 4.1.2.1.2;1.2.1.2 Pancreatic Obstruction from Neoplasm and Ascariasis;13 4.1.2.1.3;1.2.1.3 Congenital Anomalies - Pancreas Divisum;14 4.1.2.1.4;1.2.1.4 Trauma;14 4.1.2.2;1.2.2 Metabolic Etiology;14 4.1.2.2.1;1.2.2.1 Alcohol;14 4.1.2.2.2;1.2.2.2 Hypertriglyceridemia;15 4.1.2.2.3;1.2.2.3 Hypercalcemia;15 4.1.2.2.4;1.2.2.4 Post Cardiac Surgery;16 4.1.2.3;1.2.3 Miscellaneous Etiologies;16 4.1.3;1.3 Biochemical Pathogenesis of Acute Pancreatitis ;16 4.1.3.1;1.3.1 Enzyme Co-localization and Mediators of Infl ammation;16 4.1.3.2;1.3.2 Mediators of Inflammation in Acute Pancreatitis ;18 4.1.3.3;1.3.3 Systemic Manifestations of Inflammation in Acute Pancreatitis;20 4.1.4;References;21 4.2;2 Clinical Aspects of Acute Pancreatitis: Features, Prognosis and Use of Imaging Findings in Therapeutic Decision Making;23 4.2.1;2.1 Features of Acute Pancreatitis;23 4.2.2;2.2 Prognosis and Severity;24 4.2.2.1;2.2.1 Clinical Assessment of Severity;25 4.2.2.2;2.2.2 Laboratory Assessment of Severity;25 4.2.2.3;2.2.3 Radiologic Assessment of Severity;27 4.2.3;2.3 Timing and Use of Imaging in Therapeutic Decision Making;27 4.2.3.1;2.3.1 At Time of Diagnosis;27 4.2.3.1.1;2.3.1.1 Identification of Gallstones ;27 4.2.3.1.2;2.3.1.2 Confirmation of Acute Pancreatitis ;28 4.2.3.1.3;2.3.1.3 Assessment of Severity;28 4.2.3.2;2.3.2 During the First Week and Thereafter;29 4.2.3.2.1;2.3.2.1 Interstitial Pancreatitis;29 4.2.3.2.2;2.3.2.2 Necrotizing Pancreatitis;30 4.2.3.2.3;2.3.2.3 Infected Pancreatic Necrosis;32 4.2.3.2.4;2.3.2.4 Sterile Pancreatic Necrosis;35 4.2.3.2.5;2.3.2.5 Organized Necrosis;35 4.2.3.3;2.3.3 Venous Thrombosis and Solid Organ Involvement;36 4.2.3.4;2.3.4 Acute Hemorrhage;37 4.2.4;2.4 Summary;38 4.2.5;References;38 4.3;3 The Role of Ultrasound in Acute Pancreatitis;41 4.3.1;3.1 Introduction;41 4.3.2;3.2 Diagnosis;41 4.3.2.1;3.2.1 Size of the Pancreas;42 4.3.2.2;3.2.2 Echotexture of the Pancreas;42 4.3.2.3;3.2.3 Focal Changes;43 4.3.3;3.3 Extra-glandular Changes;44 4.3.3.1;3.3.1 Fluid Collections;44 4.3.3.2;3.3.2 Pancreatic Ascites;45 4.3.4;3.4 Etiologic Diagnosis;46 4.3.4.1;3.4.1 Gallstones;46 4.3.4.2;3.4.2 Biliary Ducts Stones;46 4.3.4.3;3.4.3 Idiopathic Pancreatitis;48 4.3.5;3.5 Clinical Evaluation;48 4.3.5.1;3.5.1 Severity Grading;48 4.3.5.2;3.5.2 Resolution of Acute Pancreatitis;49 4.3.6;3.6 Complications;49 4.3.6.1;3.6.1 Glandular Infections;49 4.3.6.2;3.6.2 Pseudocysts;50 4.3.6.3;3.6.3 Vascular Complications;52 4.3.7;3.7 Conclusions;52 4.3.8;References;52 4.4;4 The Role of Computed Tomography;56 4.4.1;4.1 Introduction;56 4.4.2;4.2 Pathophysiology;57 4.4.3;4.3 Clinical Signifi cance of Pancreatic Necrosis;59 4.4.4;4.4 Classification of Pancreatitis ;59 4.4.5;4.5 Diagnosis of Acute Pancreatitis;60 4.4.5.1;4.5.1 Clinical and Laboratory Features;60 4.4.6;4.6 CT Diagnosis;61 4.4.6.1;4.6.1 Technical Considerations;61 4.4.6.2;4.6.2 Normal Pancreas;61 4.4.6.3;4.6.3 Diagnostic CT Features of Acute Pancreatitis;62 4.4.6.4;4.6.4 Limitations in the CT Diagnosis;65 4.4.6.5;4.6.5 Less Common CT Presentations;65 4.4.6.5.1;4.6.5.1 Segmental Pancreatitis;65 4.4.6.5.2;4.6.5.2 Groove Pancreatitis;65 4.4.6.5.3;4.6.5.3 Autoimune Pancreatitis;67 4.4.6.5.4;4.6.5.4 Acute Exacerbation of Chronic Pancreatitis;67 4.4.7;4.7 Staging of Acute Pancreatitis;68 4.4.7.1;4.7.1 Clinical and Laboratory Evaluation;68 4.4.7.2;4.7.2 Numerical Systems;69 4.4.8;4.8 CT Staging;70 4.4.8.1;4.8.1 CT Severity Index;72 4.4.8.2;4.8.2 Limitations and Pitfalls of CT Staging;72 4.4.9;4.9 Complications of Acute Pancreatitis;73 4.4.9.1;4.9.1 Intermediate Complications;75 4.4.9.1.1;4.9.1.1 Infected Pancreatic Necrosis;75 4.4.9.1.2;4.9.1.2 Pancreatic Abscess;75 4.4.9.1.3;4.9.1.3 Pancreatic Pseudocysts;76 4.4.9.2;4.9.2 Other Complications;77 4.4.10;4.10 Lat