Acute pancreatitis — Rapid | Doctor’s Passport

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.
Repeatedly measure physiology, urine output, oxygen requirement, renal function and haematocrit or urea trends; an enzyme concentration does not grade severity.
Provide titrated analgesia, antiemesis, oxygen for hypoxaemia and carefully reassessed crystalloid resuscitation; avoid both under-resuscitation and uncritical fixed large volumes.
NICE says not to give prophylactic antimicrobials for acute pancreatitis; treat a demonstrated or strongly suspected infection such as cholangitis, pneumonia or infected necrosis.
Encourage oral feeding in mild disease as tolerated; NICE recommends enteral nutrition within seventy-two hours for moderately severe or severe pancreatitis rather than routine parenteral feeding.
Urgent ERCP is for associated cholangitis or ongoing biliary obstruction, not for every case of gallstone pancreatitis; secure definitive gallbladder management after recovery.

Key red flags

Evolving organ dysfunction

Increasing oxygen need, hypotension, oliguria, rising creatinine, confusion or acidosis signals systemic severity and requires senior and critical-care reassessment.

Biliary infection overlap

Jaundice, fever and rigors with pancreatitis may represent ascending cholangitis; urgent antibiotics and biliary decompression take priority over routine pancreatitis observation.

Haemorrhage or perforation mimic

Peritonism, gastrointestinal bleeding, abrupt collapse, pulsatile mass or pain out of proportion requires emergency imaging and surgical or vascular pathways rather than diagnostic anchoring.

Investigation priorities

Serum lipase or amylaseFirst step

Provide one diagnostic criterion in a patient with compatible acute upper-abdominal pain.

Management branches

InitialFirst-day supportive care

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.
Send diagnostic and cause-focused blood tests, perform gallbladder ultrasound and take a non-judgemental alcohol and medicine history.
Allow oral food as symptoms permit in mild illness; engage dietetics early when intake will be inadequate or disease is more severe.

Key medicines

Opioid analgesiaTitrate a short-acting intravenous, subcutaneous or oral regimen under the acute-pain protocol with frequent effect and sedation review.Reduce exposure in frailty or renal and hepatic impairment; monitor respiration, ileus, nausea, delirium and cumulative doses, and reassess escalating pain anatomically.

Crystalloid fluid replacementGive reassessed adult boluses or maintenance matched to perfusion, urine output, losses, comorbidity and local intravenous-fluid guidance.Over-resuscitation can worsen pulmonary oedema, effusions and abdominal pressure; seek critical-care support when shock persists despite an appropriate trial.

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