🩺 General MedicineGastrointestinalStudentInternResident

Acute Pancreatitis

Also known as: pancreatitis · acute abdomen · gallstone pancreatitis

Acute inflammation of the pancreas — severe epigastric pain radiating to the back, vomiting and raised enzymes. Gallstones and alcohol are the leading causes.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Adults; causes are recalled by 'I GET SMASHED' — gallstones and alcohol account for most; also hypertriglyceridaemia, drugs, ERCP and trauma.

Red flags — escalate / refer

Severe/necrotising pancreatitis with organ failure, SIRS/sepsis, hypocalcaemia or hypoxia → high-dependency/ICU.
Gallstone pancreatitis with cholangitis → urgent ERCP.

Work-up / diagnosis

1Diagnose on 2 of 3: typical pain, serum lipase/amylase >3× the upper limit, or characteristic imaging.
2Assess severity (e.g. BISAP/Glasgow) and the cause (ultrasound for gallstones, triglycerides, calcium).
3Reserve CT for assessing complications later.

Management — overview

Aggressive, goal-directed IV fluid resuscitation is the early cornerstone.
Analgesia and antiemetics; start early enteral nutrition as tolerated (avoid prolonged fasting).
Treat the cause: urgent ERCP for gallstone pancreatitis with cholangitis; cholecystectomy for gallstones (same admission if mild).
Antibiotics only for confirmed/suspected infected necrosis or cholangitis — not routine.
Monitor for complications (necrosis, pseudocyst, organ failure).

In-depthFull dosing & advanced protocol

Drug dosing

IV crystalloid

Goal-directed resuscitation

Adult dose: Titrate to perfusion and urine output; avoid over-resuscitation
Route: Intravenous

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Analgesia + antiemetics + early enteral nutrition

Supportive care

Adult dose: Adequate analgesia; feed enterally as tolerated
Route: Oral / IV

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Antibiotics (only if infected necrosis/cholangitis)

Confirmed/suspected infection

Adult dose: Per culture and local guidance
Route: Intravenous

Caution: No routine prophylactic antibiotics in acute pancreatitis.

ICMRICMR Treatment Guidelines for Antimicrobial Use in Common Syndromes (2019) ↗

Severity, necrosis & the gallstone pathway

Use a severity score plus clinical trajectory to decide on HDU/ICU care.
Infected necrosis: a step-up approach (drainage before surgery) rather than early open necrosectomy.
Gallstone disease: ERCP for cholangitis, then cholecystectomy to prevent recurrence.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV crystalloid

Analgesia + antiemetics + early enteral nutrition

Antibiotics (only if infected necrosis/cholangitis)

📈 Severity, necrosis & the gallstone pathway

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV crystalloid

Analgesia + antiemetics + early enteral nutrition

Antibiotics (only if infected necrosis/cholangitis)

📈 Severity, necrosis & the gallstone pathway

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Severity, necrosis & the gallstone pathway

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Severity, necrosis & the gallstone pathway

References