Acute Pancreatitis
Acute Pancreatitis
Acute Pancreatitis
anamnesis morbi
A 42-year-old man presents to the emergency department
complaining of severe mid-epigastric abdominal pain that radiates to
the back. The pain improves when the patient leans forwards or
assumes the fetal position and worsens with deep inspiration and
movement. He also complains of nausea, vomiting, anorexia, and
gives a history of heavy alcoholic intake this past week. He is
tachycardic, tachypnoeic, and febrile with hypotension. He is
slightly agitated and confused. He is diaphoretic with decreased
breath sounds over the base of the left lung.
Summary
• Gallstones and alcohol are the most common causes of acute pancreatitis.
• The management of acute pancreatitis includes meticulous supportive care,
with careful attention to volume status.
• Assessment of severity is an important initial step in the care of all patients
with acute pancreatitis.
• A contrast-enhanced pancreatic CT scan should be considered for patients
with severe acute pancreatitis.
• Endoscopic retrograde cholangiopancreatography should be performed in
patients with gallstone pancreatitis and signs of ongoing biliary obstruction
or cholangitis.
• Nutritional support should be administered to all patients with prolonged
NPO status or severe acute pancreatitis.
• Surgical consultation and percutaneous aspiration of pancreatic necrosis
should be considered for patients with clinical deterioration or multiorgan
system failure.