Spotlight

Acute Pancreatitis Guideline

Seth Crockett, MD, MPH ; Yngve Falck–Ytter, MD2; Sachin Wani, MD3; Timothy B. Gardner, MD, MS4
1
1
University of North Carolina School of Medicine, Chapel Hill, NC; 2Louis Stokes VA Medical Center and Division of Gastroenterology, Department of Medicine, University Hospitals
Case Medical Center, Case Western Reserve University, School of Medicine, Cleveland, Ohio; 3Division of Gastroenterology and Hepatology, University of Colorado Anschutz Medical
Campus, Aurora, Colorado; 4Section of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH

Acute pancreatitis

Mild
Moderately
severe

Normal pancreas

• Distributive shock
Severe

• Respiratory failure (ARDS)

• Renal failure

Etiology
Alcohol Gallstones Other
• Medications

• Post-ERCP
Gallstones
• Hypertriglyceridemia

• Trauma
Inflamed
pancreas • Idiopathic

• Hereditary
Gallstone
blocking duct

Recommendations
For patients with biliary pancreatitis Use goal directed fluid therapy No prophylatic antibiotics
No ERCP in absence Cholecystectomy
of cholangitis during initial admission

Initiate oral feeding (instead of NPO) Enteral nutrition For patients with alcoholic pancreatitis

For patients who are Perform alcohol counseling

intolerant of oral during initial admission
feeding, use enteral
(via either NG or
nasoenteral tube)
rather than parenteral
nutrition (TPN)
Parenteral (TPN)

Enteral (NG)

© by the AGA Institute, 2018, Vol 154, Pg 1102