Key Points
- Stabilize ABCs; begin targeted evaluation without delaying life-saving therapy.
- Use system-specific risk tools to guide testing and disposition.
- Order high-yield tests first; escalate imaging when indicated.
- Start evidence-based initial therapy and reassess frequently.
Algorithm
- Primary survey and vitals; IV access and monitors.
- Focused history/physical; identify red flags and likely etiologies.
- Order system-appropriate labs and imaging (see Investigations).
- Initiate guideline-based empiric therapy (see Pharmacology).
- Reassess response; arrange consultation and definitive management.
Clinical Synopsis & Reasoning
Acute pancreatitis is diagnosed by two of three: characteristic epigastric pain, lipase ≥3× normal, and imaging findings. Establish etiology—gallstones, alcohol, hypertriglyceridemia, medications—and assess severity using clinical scores and organ failure. Look for complications (necrosis, fluid collections) and cholangitis requiring urgent intervention.
Treatment Strategy & Disposition
Early aggressive, goal‑directed fluid resuscitation with balanced crystalloids, effective analgesia, and early enteral nutrition are cornerstone therapies. Avoid prophylactic antibiotics; treat infected necrosis when proven. Perform ERCP urgently for gallstone pancreatitis with cholangitis; schedule cholecystectomy during index admission for mild biliary disease. ICU for persistent organ failure; otherwise ward care with frequent reassessment.
Epidemiology / Risk Factors
- NSAIDs/alcohol; biliary disease
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Bleeding/anemia | Low Hgb | |
| CMP | LFTs/electrolytes | Abnormal LFTs | |
| Lipase (if pancreatitis) | Pancreatic enzyme | Elevated | |
| CT Abd/Pelvis (selected) | Complications | Findings vary |
When to Consider ERCP
| Indication | Rationale |
|---|---|
| Cholangitis present | Urgent biliary decompression |
| Persistent obstruction | Worsening cholestasis despite support |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Aggressive isotonic fluids | Volume expansion | Immediate | Early resuscitation | Fluid overload |
| Opioid analgesic | μ-receptor agonism | Minutes | Analgesia | Respiratory depression/ileus |
| Antiemetic (ondansetron) | 5-HT3 antagonism | Minutes | Nausea control | QT prolongation |
Prognosis / Complications
- Varies by etiology and bleeding severity; rebleeding/perforation
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Avoid prophylactic antibiotics in sterile necrosis. Start VTE prophylaxis and monitor for hypocalcemia and hypoxemia.
References
Use the Library, QBank, CCS, and analytics in one study workflow.
You just reviewed Acute Pancreatitis — Diagnosis and Management. MDSteps helps you turn that review into exam-style practice, missed-item flashcards, and a readiness dashboard that shows what to study next.
- 16,000+ USMLE-style questions across Step 1, Step 2, and Step 3
- CCS simulator with timed orders, live vitals, and case feedback
- Depth-on-Demand™ explanations and Anki-exportable flashcards
- Library + QBank + analytics for $27/month or $299 lifetime