Key Points
- Use the highest‑yield diagnostic test early; do not let testing delay time‑critical therapy.
- Set objective targets and reassess frequently.
- Plan definitive source control or disease‑specific therapy when indicated; document follow‑up and patient education.
Algorithm
- Confirm diagnosis; assess severity (BISAP, persistent organ failure).
- Begin LR fluids and analgesia; NPO then early enteral feeding if severe.
- Treat cause (ERCP for cholangitis/obstruction; TG-lowering; alcohol cessation).
- Monitor for complications; manage necrotizing disease with step-up approach.
Clinical Synopsis & Reasoning
Diagnose pancreatitis with 2 of 3: characteristic pain, lipase >3× ULN, or imaging. Give early goal-directed lactated Ringer’s, adequate analgesia, and start early enteral nutrition; treat causes (gallstones, alcohol, hypertriglyceridemia). Avoid routine antibiotics unless infected necrosis is suspected.
Treatment Strategy & Disposition
Stabilize ABCs. Initiate guideline‑concordant first‑line therapy with precise dosing and continuous monitoring. Escalate to advanced/procedural interventions based on explicit failure criteria. Define ICU, step‑down, and ward disposition triggers; involve specialty teams early.
Epidemiology / Risk Factors
- Risk varies by comorbidity and precipitants; see citations for condition‑specific data.
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|
| Serum lipase/amylase and RUQ ultrasound | Diagnosis/etiology | Confirm pancreatitis and look for gallstones | — |
| CT with contrast (after 48–72 h if severe) | Severity/complications | Necrosis/collections | Avoid early CT if mild |
| Triglycerides, calcium, and medication review | Etiology | Identify causes | Target therapy |
High-Risk & Disposition Triggers
| Trigger | Why it matters | Action |
|---|
| Hemodynamic instability or persistent organ failure (>48 h) | Severe pancreatitis | ICU; aggressive fluids; early nutrition |
| Suspected infected necrosis | High mortality | CT-guided FNA or empiric in select; drainage/debridement (timed) |
| Cholangitis/obstructive jaundice in gallstone pancreatitis | Obstruction/sepsis | Urgent ERCP |
| Hypoxemia or ARDS | Respiratory failure | ICU; lung-protective ventilation |
| Walled-off necrosis with sepsis or pain | Complicated course | Drainage step-up approach |
Pharmacology
| Medication/Intervention | Mechanism | Onset | Role in Therapy | Limitations |
|---|
| Lactated Ringer’s 200–500 mL/h (titrate) | Fluid resuscitation | Hours | Reduce SIRS/AKI risk | Avoid overload |
| Opioid-sparing multimodal analgesia | Pain control | Minutes | Adequate analgesia | — |
| Early enteral feeding (NG/NJ) within 24–48 h if severe | Nutrition | Hours‑days | Maintain gut integrity | — |
| Antibiotics only for infected necrosis/cholangitis | Antimicrobial | Days | Not routine in sterile necrosis | Culture-guided |
Prognosis / Complications
- Outcome depends on timeliness of diagnosis and definitive therapy; monitor for complications.
Patient Education / Counseling
- Provide red‑flag education, adherence guidance, and explicit return precautions; arrange timely specialty follow‑up.
References
- ACG pancreatitis guideline — Link