Acute Pancreatitis

Gut, Liver & Pancreas · ICU Decoded chapter 57 · Free in full

Cited to ACG 2024 / IAP-APA.

Key points

Diagnose: 2 of 3 (pain, enzymes ≥3×, imaging); cause: gallstones, alcohol, TG, drugs, hyperCa.
Early low-fat oral feeding starts within 24–48 h; give goal-directed lactated Ringer's (~1.5 mL/kg/h) over the first 12–24 h — aggressive fluids are harmful; skip prophylactic antibiotics; skip early CT — image only when the diagnosis is unclear or the patient is not improving at 48–72 h.
ERCP <24 h only for cholangitis; cholecystectomy during index admission for biliary.
Necrosis calls for waiting ≥4 wk before intervening, then a step-up approach (drain → minimally invasive → surgery).

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