Pancreatitis & Pancreatic Surgical Disease
Assess pancreatitis by organ function and complications, and recognise pancreatic malignancy and nutritional consequences.
Quick revision ↓ Medical Dictionary
01Establish the diagnosis
Acute pancreatitis is supported by characteristic pain, pancreatic enzyme elevation and imaging findings, commonly requiring two of these three diagnostic elements. Raised lipase alone can occur in other illness. Assess severity clinically and investigate the cause, including gallstones, alcohol, metabolic factors and medicines. Do not attribute every episode to alcohol simply because the patient drinks; identifying the cause prevents recurrence.
02Support physiology and nutrition
Monitor perfusion, oxygenation, kidney function and fluid balance, with reassessed rather than indiscriminately aggressive fluid treatment. Provide adequate analgesia and antiemetic care. Oral or enteral nutrition is used when suitable; prolonged fasting is not automatically necessary merely to rest the pancreas. Escalate organ dysfunction early and select the level of care according to trajectory, not the enzyme concentration alone.
03Recognise complications
Necrosis, collections, infection and persistent organ failure can complicate disease. Early CT is not required in every straightforward improving case and may not fully characterise evolving necrosis. Imaging is directed by uncertainty and clinical progress. Sterile necrosis does not automatically justify prophylactic antibiotics or immediate operation. Suspected infected necrosis needs specialist multidisciplinary planning, often with a staged minimally invasive approach when appropriate.
04Connect pancreatitis with biliary care
Gallstone pancreatitis can require duct intervention if cholangitis or persistent obstruction is present, but urgent ERCP is not mandatory for every episode. Timing of cholecystectomy depends on severity and recovery through the applicable pathway. Explain recurrence prevention and alcohol or smoking support where relevant. A discharge plan should state whether definitive treatment of the underlying cause remains outstanding.
05Consider chronic and malignant disease
Chronic pancreatitis can cause pain, malabsorption and diabetes, requiring coordinated nutritional and endocrine care. Pancreatic malignancy may present with painless jaundice, weight loss or persistent unexplained pain. Imaging, tissue assessment when indicated and staging guide treatment. Tumour markers are supportive rather than stand-alone diagnostic tests. Discuss realistic goals and nutrition early while specialist evaluation proceeds.
High-Yield Revision
- Enzyme height alone does not determine pancreatitis severity.
- Feeding and fluid treatment should follow tolerance and physiology.
- Sterile necrosis is different from infected necrosis.
Common Pitfalls
- Do not prescribe prophylactic antibiotics for every pancreatitis episode.
- Do not assume urgent ERCP is required without an appropriate biliary indication.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 27 September 2026. Consult current local protocols for prescribing, procedures and escalation.