Acute pancreatitis: management

Question 1

What is acute pancreatitis?

Answer 1

Acute pancreatitis is a serious condition associated with significant morbidity and mortality. It is managed in a hospital setting.

Question 2

How is acute pancreatitis stratified?

Answer 2

Acute pancreatitis may be stratified into three categories: Mild, Moderately severe, and Severe.

Question 3

What characterizes mild acute pancreatitis?

Answer 3

Mild acute pancreatitis is characterized by no organ failure and no local complications.

Question 4

What characterizes moderately severe acute pancreatitis?

Answer 4

Moderately severe acute pancreatitis may have no or transient organ failure (less than 48 hours) and possible local complications.

Question 5

What characterizes severe acute pancreatitis?

Answer 5

Severe acute pancreatitis is characterized by persistent organ failure (greater than 48 hours) and possible local complications.

Question 6

What is a key aspect of care for acute pancreatitis?

Answer 6

Key aspects of care include fluid resuscitation, analgesia, nutrition, role of antibiotics, and role of surgery.

Question 7

What is the recommended fluid resuscitation for severe acute pancreatitis?

Answer 7

Aggressive early hydration with crystalloids is recommended, with 3-6 litres of third space fluid loss possible.

Question 8

What is the target urine output for fluid resuscitation?

Answer 8

Aim for a urine output of greater than 0.5 mls/kg/hr.

Question 9

What is the priority of care regarding pain management?

Answer 9

Pain may be severe, so analgesia is a key priority of care.

Question 10

What type of analgesia is typically required?

Answer 10

Intravenous opioids are normally required to adequately control the pain.

Question 11

What is the nutrition guideline for patients with acute pancreatitis?

Answer 11

Patients should not routinely be made ‘nil-by-mouth’ unless there is a clear reason, such as vomiting.

Question 12

When should enteral nutrition be offered?

Answer 12

Enteral nutrition should be offered to anyone with moderately severe or severe acute pancreatitis within 72 hours of presentation.

Question 13

When should parental nutrition be used?

Answer 13

Parental nutrition should only be used if enteral nutrition has failed or is contraindicated.

Question 14

What does NICE recommend regarding antibiotics for acute pancreatitis?

Answer 14

NICE states: ‘Do not offer prophylactic antimicrobials to people with acute pancreatitis.’

Question 15

What are potential indications for antibiotics in acute pancreatitis?

Answer 15

Potential indications include infected pancreatic necrosis.

Question 16

What surgical intervention is recommended for gallstone-related acute pancreatitis?

Answer 16

Patients with acute pancreatitis due to gallstones should undergo early cholecystectomy.

Question 17

What procedure should be performed for obstructed biliary systems due to stones?

Answer 17

Patients with obstructed biliary systems due to stones should undergo early ERCP.

Question 18

What may be required for patients with worsening organ dysfunction and necrosis?

Answer 18

Patients who fail to settle with necrosis and have worsening organ dysfunction may require debridement.

Question 19

What is the management for infected necrosis?

Answer 19

Patients with infected necrosis should undergo either radiological drainage or surgical necrosectomy, depending on local expertise.