Synopsis
Diagnose acute pancreatic inflammation accurately, establish a cause, deliver evidence-based supportive care and recognise early organ dysfunction or biliary sepsis.
- Diagnose acute pancreatitis when at least two of three features are present: characteristic pain, serum lipase or amylase above three times the upper reference limit, and compatible imaging.
- Severe constant epigastric pain commonly radiates to the back and accompanies vomiting, but older, postoperative or critically ill patients can present atypically.
- Gallstones and alcohol are common causes; also assess medicines, calcium, triglycerides, trauma, recent ERCP, autoimmune disease, infection, anatomical obstruction and tumour.
Key red flags
Increasing oxygen need, hypotension, oliguria, rising creatinine, confusion or acidosis signals systemic severity and requires senior and critical-care reassessment.
Investigation priorities
Provide one diagnostic criterion in a patient with compatible acute upper-abdominal pain.
Management branches
Two diagnostic criteria establish pancreatitis or the clinical probability is high while confirmation proceeds.
- Use ABCDE, prescribe appropriate monitored analgesia and antiemesis, correct hypoxaemia and establish venous access plus urine-output observation.
- Give crystalloid for demonstrable hypovolaemia in reassessed increments, considering age, heart or kidney disease and signs of pulmonary congestion.
Key medicines
Opioid analgesiaTitrate a short-acting intravenous, subcutaneous or oral regimen under the acute-pain protocol with frequent effect and sedation review.
Crystalloid fluid replacementGive reassessed adult boluses or maintenance matched to perfusion, urine output, losses, comorbidity and local intravenous-fluid guidance.