ASGE Annual GI Advanced Practice Provider Course (Virtual) - Clinical Case-Based Learning (Day Two) | April 2023-Acute Pancreatitis Update 2023

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Acute pancreatitis is an inflammatory disorder of the pancreas and peri-pancreatic tissues that is a leading cause of gastrointestinal hospitalizations in the US. The most common causes of acute pancreatitis include gallstones and alcohol consumption, while other less common causes include medication-induced, pancreas divisum, hereditary pancreatitis, autoimmune pancreatitis, and pancreatic tumors or cystic lesions.<br /><br />Diagnosing acute pancreatitis requires abdominal pain consistent with the condition, elevated levels of serum amylase or lipase, and characteristic findings on imaging. Evaluation often includes lab tests such as liver function tests, triglyceride levels, and calcium levels, as well as imaging modalities like ultrasound and CT scans.<br /><br />The management of acute pancreatitis involves hospital admission, nil per os (NPO), intravenous fluid hydration, analgesics, and anti-emetics. The timing of initiating nutrition depends on the severity of the disease, with carbohydrate-based refeeding recommended in mild cases and early enteral nutrition for severe cases.<br /><br />In cases of complications, such as pseudocysts, drainage may be required through endoscopic, percutaneous, or surgical methods. Antibiotics are not recommended for prophylaxis but may be indicated in specific situations.<br /><br />Surgery is typically reserved for severe cases and complications, such as necrosectomy/debridement, while endoscopic procedures like endoscopic retrograde cholangiopancreatography (ERCP) are used for biliary sepsis/cholangitis and treated pancreatic ductal disruptions/leaks.<br /><br />The management of acute pancreatitis is challenging, and early diagnosis and intervention are crucial. Prognostic scoring systems are available but have limited utility, while a goal-directed approach and supportive care are key components of effective management.

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Sarah Enslin, PA-C

Keywords

acute pancreatitis

inflammatory disorder

gallstones

alcohol consumption

diagnosing acute pancreatitis

imaging

management of acute pancreatitis

nutrition

complications

surgery