Management of Pancreatitis

Key points

• Diagnosis: amylase 3x or more the upper limit (false positives/negatives occur); serum lipase is more sensitive and specific with a longer half-life; amylase level does NOT correlate with severity.
• Severity scoring: Glasgow/Ranson/APACHE II plus CRP.
• Predicting a severe attack: initial - clinical impression, BMI over 30, pleural effusion, APACHE II over 8; at 24 h - Glasgow 3 or more, persisting organ failure; at 48 h - Glasgow over 3, CRP over 150, persisting/progressive organ failure.
• Supportive care is the mainstay: aggressive IV fluid resuscitation, analgesia, and early enteral (not parenteral) nutrition, which prevents bacterial translocation. Do NOT give prophylactic antibiotics - reserve them for confirmed infected necrosis or another infection.
• Gallstone pancreatitis → early cholecystectomy; obstructed biliary system/cholangitis → early ERCP. Infected necrosis → a step-up approach (radiological/endoscopic drainage before surgical necrosectomy).

Decision points in this pathway

• Complications/aetiology?

The full step-by-step algorithm, including what to do at each branch, opens in the app for approved members.