Acute pancreatitis

Meet the patient

A 58-year-old obese woman presents with eight hours of severe epigastric pain radiating straight through to the back, repeated vomiting and jaundice. She has known gallstones. She is in pain and distressed: temperature 38.4, heart rate 124, blood pressure 92 over 58, respiratory rate 28, SpO₂ 92 percent on room air. Lipase 1240 (ULN 60), bilirubin 68, calcium 2.05. The ABG shows a PaO₂ of 7.6 kPa.[1]

The two questions that decide her next hour are the two that decide every pancreatitis: is this organ failure at the front door? (hypoxaemia and shock already answer) and can I resuscitate her without over-doing it? (WATERFALL moderate fluids answer). Hold those two and the whole management slots into place.[4][2]

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1. [1]Tenner S, Baillie J, DeWitt J, Vege SS. American College of Gastroenterology guideline: management of acute pancreatitis Am J Gastroenterol, 2013.PMID 23896955
2. [2]Banks PA, Bollen TL, Dervenis C, et al. Classification of acute pancreatitis--2012: revision of the Atlanta classification and definitions by international consensus Gut, 2013.PMID 23100216
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