Description

Gallstones and alcohol excess are responsible for most cases of acute pancreatitis which in about 10 – 20% of cases will follow a severe and protracted course. Mild cases usually have a self-limiting course and the management is simply analgesia, intravenous rehydration and return to oral intake within 5 – 7 days. Patients predicted to have severe pancreatitis should undergo an initial contrast enhanced CT scan to identify areas of pancreatic necrosis and detect complications. Necrotic pancreas is at risk of secondary infection, a major determinant of morbidity and mortality. There is evidence that prophylactic antibiotics reduce septic complications and mortality when given early to patients with necrotising pancreatitis. Urgent ERCP is indicated in patients with biliary pancreatitis who also have evidence of biliary obstruction with jaundice or cholangitis. Patients with a protracted course should receive nutritional support which may be given enterally via a feeding tube placed distal to the ligament of Treitz. Lexipafant, a platelet activating factor antagonist, may become part of the treatment regime for patients with severe pancreatitis.