Monday, March 21, 2022

Disposition of Acute Pancreatitis

emDocs - March 21, 2022 - By Jonathan Reeder
Reviewed by: Michael; Alex Koyfman; Brit Long
Acute pancreatitis is a commonly encountered etiology of abdominal pain in the ED. Despite its ubiquity, the spectrum of disease severity is broad, posing many diagnostic and disposition challenges for the emergency physician. Keep in mind the following:
  • Try to establish the etiology of the pancreatitis. Without this knowledge, our ability to predict the disease course, and therefore disposition may be limited.
  • Imaging is not necessary but may be helpful in a particularly acute patient or in one with high levels of diagnostic uncertainty. Uncovering evidence of necrosis or localized complications will change the disposition.
  • No single scoring tool is perfect. They should not be used in isolation nor override clinical judgement. However, look for key markers that may help predict morbidity/mortality:
    • SIRS criteria
    • Older age
    • Evidence of large-volume fluid shifts, refractoriness to fluid repletion"