Acute Pancreatitis: Clinical Essentials
1. Diagnosis (Atlanta Criteria)
Diagnosis requires at least 2 of the following 3 criteria:
- Typical abdominal pain (epigastric, radiating to the back).
- Serum lipase/amylase ≥ 3 times the upper limit of normal.
- Characteristic findings on cross-sectional imaging (CT, MRI, or US).
2. Etiology (GET SMASHED)
| Acronym | Cause |
|---|---|
| G, E, T | Gallstones, Ethanol, Trauma. |
| S, M, A, S, H, E, D | Steroids, Mumps, Autoimmune, Scorpion sting, Hypercalcemia/Hypertriglyceridemia, ERCP, Drugs (e.g., Azathioprine, Thiazides). |
3. Imaging & Severity
- When to CT? Not routinely indicated at admission unless the diagnosis is unclear or there is clinical deterioration after 48–72 hours.
- Signs: Peripancreatic fluid collections, fat stranding, and (in necrotizing cases) lack of glandular enhancement.
- Severity Scoring: Modified Marshall score (organ failure) or BISAP (Bedside Index for Severity in Acute Pancreatitis).
4. Management Pearls
- Fluids: Aggressive early fluid resuscitation (Lactated Ringer’s is preferred).
- Nutrition: Enteral nutrition (NG/NJ tube) is superior to parenteral nutrition if the patient cannot tolerate oral intake.
- Antibiotics: Not routinely indicated for acute pancreatitis, even with sterile necrosis. Reserved for confirmed infected necrosis.