Treatment for Pancreatitis

Initial Assessment and Classification

Pancreatitis is classified as mild (80% of cases, <5% of deaths) or severe (20% of cases, 95% of deaths) based on objective criteria 1
Laboratory assessment should include lipase, C-reactive protein, and other markers to determine severity 2, 1
Patients with persisting organ failure, signs of sepsis, or deterioration 6-10 days after admission require contrast-enhanced CT imaging 2, 3

Patients can be managed on a general ward with monitoring of vital signs 1
Oxygen saturation should be continuously monitored with supplemental oxygen to maintain arterial saturation >95% 4
Regular diet can be advanced as tolerated with appropriate pain management 1
Routine CT scanning is unnecessary unless clinical deterioration occurs 4, 1

All patients with severe acute pancreatitis should be managed in a high dependency unit or intensive therapy unit with full monitoring and systems support 2, 3
Fluid resuscitation is crucial in preventing systemic complications, with moderate fluid resuscitation preferred over aggressive resuscitation 1
Enteral nutrition is preferred over parenteral nutrition when nutritional support is required 5, 1
The nasogastric route for feeding can be used as it appears to be effective in 80% of cases 5, 3

There is no consensus on antibiotic prophylaxis in severe acute pancreatitis; evidence is conflicting 2, 3
If antibiotic prophylaxis is used, it should be given for a maximum of 14 days 2, 3
There is no proven specific drug therapy for the treatment of acute pancreatitis 4

Urgent therapeutic ERCP should be performed in patients with acute pancreatitis of suspected or proven gallstone etiology with severe disease, cholangitis, jaundice, or a dilated common bile duct 2, 3
ERCP is best carried out within the first 72 hours after the onset of pain 2, 3
All patients with biliary pancreatitis should undergo definitive management of gallstones during the same hospital admission, unless a clear plan has been made for treatment within two weeks 3

All patients with persistent symptoms and >30% pancreatic necrosis, or those with smaller areas of necrosis and clinical suspicion of sepsis, should undergo image-guided fine needle aspiration 3
Patients with infected necrosis will require intervention to completely debride all cavities containing necrotic material 2, 3
The choice of surgical technique for necrosectomy depends on individual features and locally available expertise 3