SU24.1 | Pancreatitis — Summary & Reflection

KEY TAKEAWAYS

Acute pancreatitis is autodigestion of the gland by prematurely activated enzymes, presenting with severe epigastric pain radiating to the back and vomiting, and spanning a spectrum from mild and self-limiting to severe multi-organ failure. The two commonest causes are gallstones and alcohol (GET SMASHED). Morphologically (revised Atlanta) it is interstitial oedematous (mild, common) or necrotising (severe, infection risk). Diagnosis needs two of three: characteristic pain, amylase/lipase >3× normal (lipase preferred; enzyme height does NOT predict severity), or characteristic imaging. Severity is graded by a validated score (Glasgow/Ranson, CRP >150 at 48 h) and categorised as mild / moderately severe / severe by organ-failure persistence; CECT assesses necrosis but is timed at ~72–96 h, not admission. Management is mainly supportive — aggressive fluids, analgesia, oxygen, early enteral nutrition — with NO routine antibiotics in mild disease, treatment of the cause (cholecystectomy ± urgent ERCP for gallstones), and a restrained step-up approach for infected necrosis. Complications are local (fluid collection, pseudocyst, walled-off/infected necrosis) and systemic (SIRS, ARDS, AKI, shock); prognosis tracks persistent organ failure and infected necrosis.

REFLECT

Think back to a patient you have seen with severe abdominal pain, or imagine clerking the man and the woman from the hook. Did you — or would you — apply the two-of-three diagnostic rule deliberately, and resist reading a 'very high amylase' as a 'very severe attack'? Now reflect on the discipline of early severity scoring: how would recognising persistent organ failure at 48 hours change where and how you treat a patient? Finally, consider how much of good pancreatitis care is about NOT doing things — withholding routine antibiotics in mild disease, not rushing to CT at admission, and not taking necrosis to early open surgery — and how that restraint, paired with aggressive resuscitation and treating the cause, reflects a mature, evidence-based surgical judgement rather than a reflex to intervene.