Current management of acute pancreatitis

Acute pancreatitis is a common clinical entity that presents itself a wide variety of clinical settings. The most common clinical scenario is abdominal pain with or without nausea and vomiting. The symptoms can exist alone or can complicate other disease processes. The diagnosis can be suspected by history and physical exam but is confirmed by laboratory confirmation of an elevated serum amylase concentration. The etiology of pancreatitis is usually attributable to alcohol use or gallstone disease. Other etiologies exist and can include drug reactions, trauma, metabolic derangements or infection. In approximately ten percent of cases the exact etiology is unable to be determined. Initial evaluation mandates delineation of the cause so that intervention will prevent further recurrences. The treatment of pancreatitis remains mainly supportive. Bowel rest and intravenous hydration are the cornerstones of treatment. The use of prophylactic antibiotics are controversial and surgical intervention is necessary only in severe cases of hemorrhagic pancreatitis or to manage the complications such as abscess or pseudocyst formation. The outcome following gallstone pancreatitis is generally favorable with most patients having prompt relief of symptoms and no sequelae. When there is recurrent alcohol abuse or other persistent metabolic disease recurrent acute pancreatitis can develop with a much higher risk of complications or it can progress into chronic pancreatitis. However, with appropriate treatment and intervention the majority of patients with acute pancreatitis do well.