Let's learn the management of acute pancreatitis.

1. ACUTE PANCREATITIS

2. LEARNING OBJECTIVES
 To explain principles of management of acute
pancreatitis.
 To discuss the drug therapy in acute pancreatitis.

3. MANAGEMENT OF ACUTE
PANCREATITIS
 Establishing the diagnosis and stratifying disease
 Management of pain
 Management of fluid losses
 Role of prophylactic antibiotics
 Nutritional support
 Management of complications
 Management of underlying cause

4. Management of pain
 Pethidine (Meperidine), Tramadol preferred
 No Morphine
- Morphine can induce spasm of sphincter of Oddi
and worsen biliary pancreatitis
Management of fluid losses
Fluid loss is both externally and internally
 Managed by normal saline and / or colloids

5. Role of prophylactic antibiotics
 Not indicated in mild acute pancreatitis
 Often used in severe acute pancreatitis
- Broad spectrum intravenous antibiotics like
imipenem with cilastatin and cefuroxime
Nutritional support
 ‘Nil by mouth’
 Enteral (nasogastric) feeding
-Reduces incidence of pancreatic infections

6. Management of complications
Complications Management
Hyperglycemia Using insulin
Hypocalcemia IV calcium if tetany occurs
ARDS Oxygen therapy
Acute renal failure Hemodialysis / peritoneal dialysis
Acute pseudocyst Urgent drainage into stomach /
duodenum if pseudocyst > 6cm
Pancreatic necrosis Necrosectomy

7. Management of underlying cause
 Gallstones
• Cholecystectomy (same admission)
 Role of ERCP in acute pancreatitis
• To diagnose choledocholithiasis
• To manage choledocholithiasis by biliary
sphincterotomy

8. REFERENCES
 Bailey & Love’s SHORT PRACTICE OF SURGERY
; 26th EDITION; 2013; (Page no. 1127-1133)
 Davidson’s Principles & Practice of Medicine ; 21st
EDITION; 2010; (Page no. 889-891)
 HARRISON’S PRINCIPLES OF INTERNAL
MEDICINE ; 18th EDITION; VOLUME 2; 2012 ;
( Page no. 2635-2643)

9. “THANK YOU”