SHM's Clinical Quick Talks-Acute Pancreatitis

Pdf Summary

Acute pancreatitis is an inflammatory condition of the pancreas characterized by premature activation of trypsinogen within pancreatic acini, leading to pancreatic tissue destruction and a systemic inflammatory response. The most common causes include gallstones (21%-33%, varying geographically), alcohol use (16%-27%), idiopathic origins (17%), hypertriglyceridemia (particularly >1000 mg/dL), post-ERCP injury, and other factors such as medications, hypercalcemia, autoimmune conditions, and structural anomalies.<br /><br />Clinically, patients present with constant epigastric abdominal pain often radiating to the back, accompanied by nausea and vomiting, along with abdominal tenderness and distension. Diagnosis is established by the Revised Atlanta Criteria, requiring two of the following: characteristic abdominal pain, serum lipase or amylase levels three times above normal, and imaging findings suggestive of pancreatitis on CT or MRI. Imaging is not necessary for all; ultrasound is preferred early to evaluate for gallstones especially in the U.S., and CT is reserved for uncertain diagnoses or complications after 48-72 hours.<br /><br />Management includes early fluid resuscitation, preferably with lactated Ringer’s solution, balancing volume to avoid overload; initial bolus followed by maintenance rates may be tailored based on patient status. Early enteral feeding within 24 hours supports gut barrier function and improves outcomes. In gallstone pancreatitis, early cholecystectomy during the same admission is recommended, and ERCP within 24 hours is indicated if cholangitis is present. Pain control follows WHO analgesic guidelines; opioids are acceptable despite theoretical concerns. Prophylactic antibiotics are not advised unless infection is suspected.<br /><br />Lipase levels need not be trended during hospitalization as they do not correlate with severity. Common complications include peripancreatic fluid collections, necrosis, pseudocysts, splenic vein thrombosis, respiratory distress, ileus, and progression to chronic pancreatitis.<br /><br />Key clinical points highlight the utility of the Revised Atlanta Criteria for diagnosis, the importance of ultrasound for gallstone detection, and vigilance for complications even in mild cases. This overview assists clinicians in diagnosis and evidence-based management of acute pancreatitis.

Asset Subtitle

Magdy El-din

Keywords

acute pancreatitis

pancreas inflammation

trypsinogen activation

gallstones

alcohol-induced pancreatitis

hypertriglyceridemia

Revised Atlanta Criteria

lipase and amylase levels

fluid resuscitation

early enteral feeding