Acute Pancreatitis: Diagnosis and Management

Diagnostic Criteria

Requires 2 of 3: abdominal pain consistent with pancreatitis, amylase/lipase >3x upper limit, characteristic imaging. Lipase is more specific. Early CT not recommended unless diagnosis uncertain.

Initial Management

Aggressive IV hydration with lactated Ringer's preferred. Early oral feeding (within 24h if tolerated) improves outcomes. Pain control with IV acetaminophen and opioids as needed.

Severity Assessment

Modified Atlanta Classification guides management. BISAP score and CRP help predict severe course. Necrotizing pancreatitis requires specialist care and possible intervention.

Etiologic Evaluation

Gallstones and alcohol cause 80% of cases. TG >1000 mg/dL suggests hypertriglyceridemia. MRCP/EUS evaluate for microlithiasis, tumors, or anatomic abnormalities if no clear cause.

Preventing Recurrence

Cholecystectomy for gallstone pancreatitis within index admission. Alcohol cessation counseling. Treat hypertriglyceridemia. ERCP with sphincterotomy for SOD if recurrent idiopathic cases.