Medical management of mild acute pancreatitis is relatively straightforward. The patient is kept NPO (nil per os—that is, nothing by mouth), and intravenous (IV) fluid hydration is provided. Analgesics are administered for pain relief. Antibiotics are generally not indicated.
If ultrasonograms show evidence of gallstones and if the cause of pancreatitis is believed to be biliary, a cholecystectomy should be performed during the same hospital admission. Feeding should be introduced enterally as the patient’s anorexia and pain resolves. Patients can be initiated on a low-fat diet initially and need not invariably start their dietary advancement using a clear liquid diet.
Serum amylase and lipase levels can be elevated in patients with brain injury (eg, cerebrovascular accident or brain trauma). These patients are generally cared for in an intensive care unit (ICU) and require mechanical ventilation. Pancreatic enzyme elevations may rise and fall dangerously over many days to weeks. The elevation is believed to result from hyperstimulation of the pancreas via a central mechanism, but no evidence of acute pancreatitis is present on imaging studies.
Patients with severe acute pancreatitis require intensive care. Within hours to days, a number of complications (eg, shock, pulmonary failure, renal failure, gastrointestinal [GI] bleeding, or multiorgan system failure) may develop. The goals of medical management are to provide aggressive supportive care, to decrease inflammation, to limit infection or superinfection, and to identify and treat complications as appropriate.
