Diagnosis and Management of Acute Pancreatitis

Diagnosis

The diagnosis of acute pancreatitis should be made within 48 hours of admission and requires a combination of clinical assessment, laboratory testing, and imaging studies to ensure accurate diagnosis and prevent missing other life-threatening conditions 1
Upper abdominal pain and vomiting with epigastric or diffuse abdominal tenderness are common clinical findings 2
Serum amylase activity ≥4 times above normal or lipase activity ≥2 times the upper limit of normal is diagnostic in the appropriate clinical setting 1, 2
Lipase is preferred over amylase due to higher specificity, longer elevation period, and higher sensitivity 2, 3
Other helpful laboratory markers include C-reactive protein (CRP), Procalcitonin (PCT), and White blood cell count 4
Ultrasound examination should be performed initially in all patients with suspected acute pancreatitis to detect gallstones, free peritoneal fluid, and bile duct dilation 2
CT scan with IV contrast is indicated when clinical and biochemical findings are inconclusive or severe disease is predicted 2, 3

Treatment approach should be based on severity classification (mild, moderately severe, or severe) 4
For mild acute pancreatitis, regular diet with advancement as tolerated, oral pain medications, and routine vital signs monitoring are recommended 4
For moderately severe acute pancreatitis, enteral nutrition, IV pain medications, IV fluids to maintain hydration, and monitoring of hematocrit, blood urea nitrogen, and creatinine are recommended 4
For severe acute pancreatitis, enteral nutrition, IV pain medications, early fluid resuscitation, mechanical ventilation if needed, and organ support as required are recommended 4
Routine prophylactic antibiotics are not recommended for all patients with acute pancreatitis, but should be administered only to treat infected acute pancreatitis 4
For infected pancreatitis without multidrug-resistant (MDR) organisms, antibiotic options include Meropenem, Doripenem, and Imipenem/cilastatin 4
Endoscopic retrograde cholangiopancreatography (ERCP) should be performed as soon as possible in patients with acute biliary pancreatitis and common bile duct obstruction 4

Overall mortality should be lower than 10%, and less than 30% in those diagnosed with severe disease 5