Gastroenterology · Ward Pathways · Free — no sign-in
Epigastric pain → back, N/V; gallstones / alcohol
ABCDE
IV access, moderately aggressive LR fluids (~1.5 mL/kg/h after bolus if hypovolemic); analgesia; O₂; monitor for organ failure; catheter.
Calculators:
Confirm:Lipase (>3× ULN); CT for complications/severity
Treat:Moderately aggressive LR (10 mL/kg bolus if hypovolemic, then ~1.5 mL/kg/h; reassess within 6 h and at 24–48 h — do not continue aggressive hydration beyond 48 h) + analgesia + early oral feeding (low-fat solids within 24–48 h in mild AP; NPO only for ileus/severe nausea; NG enteral over parenteral in severe AP)
Gallstone + cholangitis →ERCP; cholecystectomy same admission
Order set
Lipase
FBC, U&E, Ca, glucose, LFTs
Moderately aggressive LR ~1.5 mL/kg/h (NOT 30 mL/kg)
USS (gallstones)
CT only if diagnosis unclear or no improvement at 48–72 h (not routine on admission)
Rectal indomethacin (± PD stent) for post-ERCP pancreatitis prophylaxis
Escalate / ICU
Persistent SIRS / organ failure >48 h
Hypoxia, oliguria, hypotension
High-volume resuscitation → HDU/ICU
Criteria
AdmitAll acute pancreatitis
ICUPersistent organ failure, severe SIRS, necrosis
IntubateARDS / respiratory failure
VasopressorsDistributive shock despite fluids
DialysisAKI with AEIOU
DischargePain controlled, eating, organ failure resolved, cause addressed
Never
Give prophylactic antibiotics unless infected necrosis
Early (<72 h) ERCP for biliary pancreatitis WITHOUT cholangitis — medical therapy first (ACG 2024)
Clinical detail — differentials, red flags, pitfalls, disposition
Red flags
Persistent SIRS/organ failure
Hypocalcaemia
Necrosis
Differentials
Perforated ulcer
Cholangitis
Mesenteric ischaemia
AAA
Common mistakes
Prophylactic antibiotics
Under-resuscitation
Delaying feeding
Disposition & follow-up
Severity scoring; HDU/ICU if organ failure; ERCP if cholangitis.
Discharge package
MedicationsAnalgesia; treat cause
Follow-upCholecystectomy if gallstones; alcohol support
DoseAcute pancreatitis: moderately aggressive — 10 mL/kg bolus if hypovolemic, then ~1.5 mL/kg/h; reassess at 6 h and 24–48 h; do NOT continue aggressive hydration beyond 48 h (fluid overload/respiratory failure — WATERFALL; ACG 2024)
Preparation500/1000 mL bags; contains K⁺ 4–5 mmol/L — still safe in most hyperK resuscitation
MonitorPerfusion (cap refill, urine, lactate) vs pulmonary oedema every aliquot
Morphineopioid analgesic
Dose2.5–10 mg IV q1–2 h PRN; PCA 1 mg bolus, 5–10 min lockout
Preparation10 mg/mL ampoule — dilute to 1 mg/mL for titration
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.