One-page cheat sheet
Acute pancreatitis
Diagnose, predict severity, resuscitate
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Causes
- Gallstones and alcohol: about 80%
- Hypertriglyceridaemia (over 11.3 mmol/L), hypercalcaemia, post-ERCP, drugs (azathioprine, valproate, thiazides)
- Trauma, viruses (mumps), autoimmune, scorpion venom, idiopathic
Diagnosis: 2 of 3
- Typical epigastric pain radiating to the back
- Lipase (or amylase) over 3 times normal
- Typical features on imaging
- CT is not needed when the diagnosis is clear; do it after 72–96 hours if not improving
Severity
- Revised Atlanta: mild (no organ failure); moderately severe (organ failure under 48 h or local complications); severe (organ failure over 48 h)
- Predictors: Glasgow-Imrie 3 or more (48 h), BISAP 3 or more, CRP over 150 mg/L at 48 h
- Amylase level does not predict severity
Management
- Goal-directed, moderate fluids (Hartmann’s / Ringer’s lactate): aggressive fluids cause harm
- Analgesia (opioids are fine), oxygen, monitor urine output
- Early oral feeding when tolerated; enteral before parenteral
- No prophylactic antibiotics
- ERCP within 24 h only for cholangitis
- Mild gallstone pancreatitis: cholecystectomy on the same admission
Local complications
- Under 4 weeks: acute peripancreatic fluid or acute necrotic collection
- Over 4 weeks: pseudocyst (no necrosis) or walled-off necrosis
- Infected necrosis: antibiotics, then the step-up approach (drainage, then minimally invasive necrosectomy), ideally after 4 weeks
Don’t miss
- Hypocalcaemia, hyperglycaemia, AKI, ARDS
- Splenic vein thrombosis, pseudoaneurysm bleeding
- Abdominal compartment syndrome in severe disease
Exam pearls
- Glasgow-Imrie mnemonic: PANCREAS
- Grey Turner’s (flanks) and Cullen’s (umbilicus) signs: haemorrhagic pancreatitis
- Look for the cause in every case: ultrasound for stones, triglycerides, calcium