Confusion exists in the terminology describing the clinical stages of acute pancreatitis and the associated pathology in the pancreas of the patient surviving the initial episode. We believe that this confusion is due to an attempt to label clinically a specific phase of a continuous pathologic process in the pancreas, beginning with edema and progressing to complete fibrosis. That such terminology is misleading is shown by the fact that all of the clinical manifestations of so-called "chronic" pancreatitis—pancreatic insufficiency, cyst formation, and calcification—are found in acute pancreatitis. Furthermore, when the pancreas undergoes complete fibrosis, it becomes an inert structure and should not cause pain. Such patients require only pancreatic supplements.
Terminology should be based on the acute pathology of the pancreas: (1) edema; (2) hemorrhage; (3) necrosis; (4) suppuration, and (5) fat necrosis.
Since our diagnosis must be clinical, the following clinical picture of acute pancreatitis is used:
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