Early phase of acute pancreatitis: Assessment and management

Abstract

Acute pancreatitis (AP) is a potentially life-threatening disease with a wide spectrum of severity. The overall mortality of AP is approximately 5%. According to the revised Atlanta classification system, AP can be classified as mild, moderate, or severe. Severe AP often takes a clinical course with two phases, an early and a late phase, which should both be considered separately. In this review article, we first discuss general aspects of AP, including incidence, pathophysiology, etiology, and grading of severity, then focus on the assessment of patients with suspected AP, including diagnosis and risk stratification, followed by the management of AP during the early phase, with special emphasis on fluid therapy, pain management, nutrition, and antibiotic prophylaxis.

Keywords: Acute pancreatitis; Incidence; Pathophysiology; Etiology; Severity; Risk stratification; Fluid therapy; Pain management; Nutrition; Antibiotic prophylaxis

Core tip: Acute pancreatitis is a frequent and potentially life-threatening disease. Therapy is currently mostly symptomatic with fluid resuscitation, pain management, and early oral feeding. Vigorous fluid resuscitation remains a cornerstone of early management of acute pancreatitis. Cross-sectional imaging during the early phase of evaluation has not been associated with improvement in outcome. There is no role for prophylactic antibiotics in the management of the early phase of acute pancreatitis (AP). Enteral nutrition in AP can reduce mortality, systemic infections, and multiorgan dysfunction compared to parenteral nutrition. Immediate endoscopic retrograde cholangiography is indicated only in patients with biliary pancreatitis with common bile duct obstruction and cholangitis.