Abstract
Background
Acute pancreatitis is a frequent reason for patient presentation to the emergency
department (ED) and the most common gastrointestinal disease resulting in admission.
Emergency clinicians are often responsible for the diagnosis and initial management
of acute pancreatitis.
Objective
This review article provides emergency clinicians with a focused overview of the diagnosis
and management of pancreatitis.
Discussion
Pancreatitis is an inflammatory process within the pancreas. While the disease is
often mild, severe forms can have a mortality rate of up to 30%. The diagnosis of
pancreatitis requires two of the following three criteria: epigastric abdominal pain,
an elevated lipase, and imaging findings of pancreatic inflammation. The most common
etiologies include gallbladder disease and alcohol use. After the diagnosis has been
made, it is important to identify underlying etiologies requiring specific intervention,
as well as obtain a right upper quadrant ultrasound. The initial management of choice
is fluid resuscitation and pain control. Recent data have suggested that more cautious
fluid resuscitation in the first 24 h might be more appropriate for some patients.
Intravenous opiates are generally safe if used judiciously. Appropriate disposition
is a multifactorial decision, which can be facilitated by using Ranson criteria or
the Bedside Index of Severity in Acute Pancreatitis score. Complications, though rare,
can be severe.
Conclusions
Pancreatitis is a potentially deadly disease that commonly presents to most emergency
departments. It is important for clinicians to be aware of the current evidence regarding
the diagnosis, treatment, and disposition of these patients.
Keywords
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Article info
Publication history
Published online: September 26, 2018
Accepted:
August 3,
2018
Received:
July 22,
2018
Footnotes
This review does not reflect the views or opinions of the US Government, Department of Defense, US Army, US Air Force, or San Antonio Uniformed Services Health Education Consortium Emergency Medicine Residency Program.
Identification
Copyright
Published by Elsevier Inc.
