2025 Multiprofessional Critical Care Review: Adult Online-Acute Pancreatitis

Video Transcription

Video Summary

The discussion centers on acute severe pancreatitis diagnosis and management in a 45-year-old male with worsening abdominal pain, elevated lipase, organ dysfunction, and borderline vitals. Severe pancreatitis is defined by persistent organ failure (renal, respiratory, or cardiovascular) lasting >48 hours, assessed by scores like modified Marshall or Ranson’s criteria. Patients with severe disease require ICU admission. Initial management includes early fluid resuscitation with lactated Ringer’s unless hypercalcemia exists, pain control avoiding morphine, and close monitoring. Imaging starts with abdominal ultrasound; CT scans with contrast are reserved for worsening or complicated cases after 72 hours. Prophylactic antibiotics are not recommended as they increase harm without improving outcomes. Early enteral feeding via oral or nasogastric routes is preferred over total parenteral nutrition. Interventions for necrosis or infection are delayed unless clinical deterioration occurs, progressing from antibiotics to drainage and possibly surgery. Gallstone pancreatitis management depends on evidence of cholangitis and may need ERCP. Venous thrombosis is common and anticoagulated safely, unlike arterial pseudoaneurysm bleeding.

Keywords

acute severe pancreatitis

organ failure

fluid resuscitation

imaging modalities

enteral feeding

gallstone pancreatitis

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