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Pancreatitis, Acute

Robert L. Frachtman, MD and Marni L. Martinez, APRN Reviewed 06/2019
 


BASICS

DESCRIPTION

Acute inflammation of the pancreas with variable involvement of regional tissue or remote organ systems 
  • Inflammatory episode with symptoms related to intrapancreatic activation of en...

DIAGNOSIS

Symptoms don’t always correlate with objective findings. 

HISTORY

  • Acute onset of “boring” epigastric pain, which may radiate toward the back

  • Nausea/vomiting

  • Alcohol use

  • Personal or family history...

TREATMENT

MEDICATION

First Line

  • Analgesia: no consensus; guidelines vary: hydromorphone (Dilaudid) 0.5 to 1.0 mg IV q1–2h PRN

    • AVOID meperidine (Demerol) due to the potential of accumulation of a toxic me...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Follow-up imaging in several weeks if the original CT scan showed a fluid collection or necrosis or if the amylase/lipase continues to be elevated. Follow-up find...

REFERENCES

1
Forsmark CE, Vege SS, Wilcox CM. Acute pancreatitis. N Engl J Med.  2016;375(20):1972–1981. [View Abstract on OvidMedline]
2
Gravante G, Garcea G, Ong SL, et al. Prediction of mortality...

ADDITIONAL READING

  • Crockett SD, Wani S, Gardner TB, et al; for American Gastroenterological Association Institute Clinical Guidelines Committee. American Gastroenterological Association Institute guid...

CODES

ICD10

  • K85.9 Acute pancreatitis, unspecified

  • K85.8 Other acute pancreatitis

  • K85.2 Alcohol induced acute pancreatitis

  • K85.3 Drug induced acute pancreatitis

  • K85.1 Biliary acute pancreatitis

  • K85.0 Idiopat...

CLINICAL PEARLS

  • Pancreatitis is a common cause of hospitalization.

  • Gallstones and alcohol misuse are the leading causes of pancreatitis.

  • The BISAP score is easier to apply than Ranson criteria and just ...

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