ABSTRACT

Acute pancreatitis (AP) is a common cause of gastrointestinal emergencies which is associated with significant morbidity and mortality. The diagnosis of AP is established by any two of the following: a) typical symptoms, b) elevated amylase or lipase and c) radiological features. Trans-abdominal ultrasound should be performed in all patients with suspected acute pancreatitis to evaluate the biliary tract and determine the presence of gallstones. The majority of cases of AP are due firstly, to biliary disease and secondly, alcohol use. It is important to determine the severity of AP which will indicate course and prognosis. The prognostic features can be initially assessed by clinical impression, the APACHE 11 score, the C-reactive protein and evidence of persistent organ failure. The severity of AP is classified as mild, moderately severe and severe. In mild disease, there is no organ failure, local or systemic complications. Patients with moderately severe AP have transient, less than 48 hours, organ failure or systemic complications. Severe AP is associated with persistent organ failure and/or systemic or local complications. The initial management consists of early aggressive fluid resuscitation, 250‒500 mL per hour or 5‒10 mL per kilogram bodyweight per hour of isotonic crystalloid solution. Use of prophylactic antibiotics is not recommended. Antibiotics should be administered in suspected or confirmed extra-pancreatic infection or infected pancreatic necrosis. Feeding of patients should be commenced early and after adequate fluid resuscitation. The enteral route utilizing a nasogastric tube in patients with gut dysfunction in severe AP and oral feeding in patients with normal gut function in mild AP are appropriate.