Send Feedback

Print

Mobile

 Back

CDHB

Acute Pancreatitis

See also the Acute Pancreatitis Pathway which is in the Surgical Wards and the Emergency Department (search for "C240280" on the CDHB intranet).

Clinical Features

• Epigastric pain is the dominant symptom and may range from mild to excruciating and may radiate to back.
• Fever, tachycardia, hypotension, abdominal distention and rigidity may occur.
• Shock.
• Hypoxia.
• Hypocalcaemia.

Note: Bacterial sepsis may also be present.

Diagnosis

• Serum amylase or lipase is usually elevated at least 3 x above normal range in appropriate clinical setting. Other abdominal diseases may cause a lesser elevation of amylase.

Aetiology

• Gallstones.
• Alcohol.
• Idiopathic.
• Drugs.
• Types I and V hyperlipidaemia.

Investigations

• Serum amylase. Serum lipase only required if amylase is normal and there is a strong clinical suspicion of pancreatitis, especially with a history of pain for more than 48 hours.
• CBC + diff.
• Na, K, Ca, PO₄, creatinine, glucose, LDH, bili, ALP, AST, ALT, GGT, CRP.
• Blood cultures.
• Abdominal ultrasound.
• Arterial blood gases.
• Lipids if CBC is lipaemic or triglycerides over 15 mmol/L. Specimen can be non-fasting.
• CXR.

Management

• Treatment of shock.
• Pain relief - early consideration of patient-controlled anaesthesia (PCA). Contact the Acute Pain Management Service or the Duty or on-call Anaesthetist.
• Patients should eat and drink as tolerated.
• Oxygen therapy- serial blood gases (ARDS, acidosis).
• Correct electrolytes and calcium disturbances.
• Antibiotics - only if co-existing cholangitis.
• Surgical consult.
• Consider urgent ERCP if (severe) coexisting cholangitis. Features include - jaundice, abnormal LFTs and abnormal biliary tract on imaging.
• If triglycerides (TGs) greater than 15 mmol/L, urgent management is required:
  • If patient is hyperglycaemic, start an insulin infusion (e.g., as for DKA). Insulin is required for the clearance of triglyceride-rich chylomicron particles.
  • If TGs 15 to 50 mmol/L, request acute general medicine review after hours, followed by lipid specialist review next working day. Phone Clinical Nurse Specialist on 88252 or page 8377, or phone Prof Russell Scott or Prof Peter George via the hospital operator. Fax consult form to 81114.
  • If TGs over 50 mmol/L, arrange immediate plasma exchange to ensure rapid control of TG levels. Transfer the patient to ICU or SPCU. Contact both the NZBS on-call transfusion specialist and the lipid specialist urgently via the Christchurch Hospital operator.
  • Monitor lipid levels daily.

The following are associated with a poor prognosis:

Topic Code: 1433