SHM's Clinical Quick Talks-Acute Pancreatitis: Presentation, Diagnosis, and Management

Pdf Summary

Acute pancreatitis (AP) is the acute inflammation of the pancreas parenchyma and its incidence has been steadily increasing in the Western world. The most common causes of AP are gallstone-induced and alcohol-related. Other less common causes include hypertriglyceridemia, hypercalcemia, autoimmune factors, post-ERCP, toxins, and certain medications. Patients typically present with acute epigastric pain, nausea, and vomiting, and may exhibit fever, tachycardia, and tachypnea. Diagnosis of AP is established if the patient meets two out of three criteria: epigastric pain with or without back radiation, elevated serum lipase or amylase, and abdominal imaging findings consistent with AP. Lipase is preferred for diagnosis. Management includes pain control, intravenous fluid resuscitation, and early feeding as tolerated. Fluid resuscitation within the first 24-48 hours has been shown to decrease morbidity and mortality. Enteral feeds are preferred over total parenteral nutrition, and early enteral feeding may reduce the length of stay. Severity and mortality risk calculators such as Ranson's criteria and the bedside index of severity in acute pancreatitis (BISAP) can help guide appropriate inpatient disposition. Patients with higher scores may require repeat imaging and surgical consultation for assessment of complications. Evaluation for microlithiasis is recommended for patients with idiopathic pancreatitis, using endoscopic ultrasound as the gold standard. Overall, early diagnosis, appropriate management, and comprehensive treatment are key in the management of acute pancreatitis.

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Alexander Garcia, Avneet Singh, Kathryn Haroldson

Keywords

Acute pancreatitis

pancreas inflammation

gallstone-induced AP

alcohol-related AP

hypertriglyceridemia

hypercalcemia

autoimmune factors

fluid resuscitation

enteral feeding

microlithiasis evaluation