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
- Risk factors vary by condition and patient profile
Investigations
| Test | Role / Rationale | Typical Findings | Notes |
|---|---|---|---|
| CBC | Baseline hematology | Abnormal counts | |
| BMP | Electrolytes/renal | Derangements |
Secondary Causes
| Cause | Comment |
|---|---|
| Uncontrolled diabetes | Optimize insulin and diet |
| Alcohol use | Abstinence reduces recurrence |
| Medications | Review estrogens, retinoids |
Pharmacology
| Medication | Mechanism | Onset | Role in Therapy | Limitations |
|---|---|---|---|---|
| Acetaminophen | Analgesic/antipyretic | Hours | Symptom control as appropriate | Hepatotoxicity (overdose) |
| Ondansetron | 5-HT3 antagonism | Minutes | Antiemesis if needed | QT prolongation |
Prognosis / Complications
- Prognosis depends on severity, comorbidities, and timeliness of care
Patient Education / Counseling
- Explain red flags and when to seek emergent care.
- Reinforce medication adherence and follow-up plan.
Notes
Coordinate with critical care for severe cases. Hydration and standard pancreatitis care remain essential.