RT Book, Section A1 Singh, Ajaypal A1 Gelrud, Andres A2 Hall, Jesse B. A2 Schmidt, Gregory A. A2 Kress, John P. SR Print(0) ID 1107711999 T1 Acute Pancreatitis T2 Principles of Critical Care, 4e YR 2015 FD 2015 PB McGraw-Hill Education PP New York, NY SN 9780071738811 LK accessmedicine.mhmedical.com/content.aspx?aid=1107711999 RD 2024/03/28 AB Acute pancreatitis is a frequent cause of gastrointestinal-related critical illness.Most cases are caused by alcohol and gallstones; other etiologies include hypertriglyceridemia, post-ERCP pancreatitis, hypercalcemia, trauma, infections, and medications.Two of the following three criteria establish the diagnosis of acute pancreatitis: sudden onset of characteristic abdominal pain; serum amylase and/or lipase above three times normal; pancreatic inflammation on imaging studies.There are two types of acute pancreatitis—interstitial edematous and necrotizing. The former has pancreatic enlargement with diffuse pancreatic and peripancreatic inflammation. The latter has necrosis of pancreatic and/or peripancreatic tissue, in addition to inflammatory changes.Early crystalloid administration in fluid-responsive patients is important in the management of acute pancreatitis.Early enteral nutrition has been validated as an important component of the management of acute pancreatitis; avoiding enteral feeding and/or use of parenteral nutrition is not recommended.There is no role for prophylactic antibiotics in the management of acute pancreatitis; however, broad spectrum antibiotics (eg, carbapenems) are indicated in the presence of documented or suspected pancreatitic infection.Endoscopic retrograde cholangiopancreatography (ERCP) is indicated in patients with acute gallstone pancreatitis with cholangitis and those with pancreatic duct disruption.Endoscopic debridement is superior to open necrosectomy for the management of mature, walled-off fluid collections.