MANAGEMENT OF

ACUTE PANCREATITIS
A Clinical Practice Guideline developed by
‘Best Practice in Surgery’

Hassan Bin Ajmal, MBBS

PGY1 General Surgery Resident
Surgical Unit – 1
Dr. Ruth K. M. Pfau Civil Hospital Karachi
APPROACH
 CLINICAL PRESENTATON
• Pain is the cardinal symptom – severe, develops quickly,
reaching maximum intensity within minutes and persists for
hours or even days. The pain is constant and refractory to
the usual doses of analgesics. Usually starts in epigastrium,
may be localized to either upper quadrant or diffuse
throughout the abdomen. It may radiate to the back (50%).

• Nausea, repeated vomiting, retching and hiccoughs.

 CLINICAL PRESENTATON
• A well-looking patient or, at the other extreme, one who is gravely ill
with profound shock, toxicity and confusion.

• Tachypnea, tachycardia, and hypotension. The body temperature is

often normal or even subnormal. Signs of SIRS.

• Mild icterus can be caused by biliary obstruction in gallstone

pancreatitis, and an acute swinging pyrexia suggests cholangitis.

• Abdominal examination may reveal distension due to ileus or, more

rarely, ascites with shifting dullness. A mass can develop in the
epigastrium due to inflammation. There is usually muscle guarding in the
upper abdomen, although marked rigidity is unusual.
INVESTIGATIONS
 DIAGNOSIS
2 of the following (Atlanta Classification 2012):

1. Abdominal pain (acute onset of a persistent,

severe, epigastric pain often radiating to the back).

2. Serum lipase activity (or amylase) at least three

times greater than the upper limit of normal.

3. Characteristic findings of acute pancreatitis on CT

or MRI.
 Differential Diagnosis

• Perforated Peptic Ulcer

• Acute Cholecystitis
• Biliary Colic
• Myocardial Infarction
Etiology
ASSESSMENT
Prognostic Criteria (Ranson Score)
Severity Assessment (Atlanta criteria)
CT Severity Index for Morbidity and Mortality
MANAGEMENT
GUIDELINES
 REFERENCES
• Guidelines – BPIGS - Best Practice in Surgery
http://bestpracticeinsurgery.ca/guidelines/

• Bailey & Love's Short Practice of Surgery – 27th Edition.

• Sabiston Textbook of Surgery - 20th Edition.

THANK YOU!