Hospitalist Clinical Practice Guidelines: 2018 Midyear Review

John Anello; Brian Feinberg; John Heinegg; Yonah Korngold; Richard Lindsey; Cristina Wojdylo; Olivia Wong, DO


July 03, 2018

In This Article

Acute Pancreatitis

American Gastroenterological Association

The diagnosis of acute pancreatitis (AP) requires at least 2 of the following features: characteristic abdominal pain; biochemical evidence of pancreatitis (ie, amylase or lipase elevated >3 times the upper limit of normal); and/or radiographic evidence of pancreatitis on cross-sectional imaging.

Presentations of AP occur along a clinical spectrum and can be categorized as mild, moderately severe, or severe, based on the recent revised Atlanta classification.

Most cases of AP (around 80%) are mild, with only interstitial changes of the pancreas without local or systemic complications.

Moderately severe pancreatitis is characterized by transient local or systemic complications or transient organ failure (<48 hours), and severe AP is associated with persistent organ failure.

Necrotizing pancreatitis is characterized by the presence of pancreatic and/or peripancreatic necrosis, and is typically seen in patients with moderately severe or severe AP.

There are 2 overlapping phases of AP, early and late. The early phase of AP takes place in the first 2 weeks after disease onset, and the late phase can last weeks to months thereafter.

In patients with AP, the AGA suggests against the use of hydroxymethyl starch (HES) fluids.

In patients with predicted severe AP and necrotizing AP, the AGA suggests against the use of prophylactic antibiotics.

In patients with acute biliary pancreatitis and no cholangitis, the AGA suggests against the routine use of urgent ERCP.

In patients with AP, the AGA recommends early (within 24 hr) oral feeding as tolerated, rather than keeping the patient nil per os.

In patients with AP and inability to feed orally, the AGA recommends enteral rather than parenteral nutrition.

In patients with predicted severe or necrotizing pancreatitis requiring enteral tube feeding, the AGA suggests either nasogastric or nasojejunal route.

In patients with acute biliary pancreatitis, the AGA recommends cholecystectomy during the initial admission rather than after discharge.

In patients with acute alcoholic pancreatitis, the AGA recommends brief alcohol intervention during admission.



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