Acute Pancreatitis

The incidence of acute pancreatitis in the United States is among the highest worldwide and can be difficult to diagnose clinically. Patients may present with severe, persistent upper abdominal pain with serum lipase three times the upper normal limit. Computed tomography (CT) imaging may show signs of pancreatic inflammation, such as ill-defined pancreatic margins. Depending on organ failure status or systemic symptoms, patients can have mild, moderately severe, or severe acute pancreatitis (AP). Intravenous fluids (preferably lactated Ringer’s (LR)) and pain control are the mainstays of treatment. Depending on the severity of AP and various laboratory and physical exam results, patients may need to be treated in the intensive care unit (ICU) with close monitoring of their kidney and cardiac function and to prevent worsening symptoms. After 72 h, if they have failed to improve or are continuing to decline, consider a computed tomography (CT) scan with contrast for assessment of possible necrosis or local complications, such as collection of fluid or sepsis. If an infection is present, treatment with intravenous (IV) antibiotics should begin. Debridement via necrosectomy may be necessary after 4 weeks, if the infection persists. Endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy should be performed within 24 h if gallstone pancreatitis and cholangitis are suspected.