Why does acute pancreatitis require hospital admission?

From the Guidelines

Acute pancreatitis requires hospital admission because it is a potentially life-threatening condition that needs close monitoring and supportive care. Patients with acute pancreatitis need intravenous fluid resuscitation to maintain adequate hydration and blood pressure, as the inflammatory process causes significant third-spacing of fluids 1. Pain management with opioid analgesics such as morphine or hydromorphone is essential, typically administered at regular intervals or via patient-controlled analgesia. Nutritional support is crucial, with early enteral feeding recommended in most cases, usually within 24-48 hours if tolerated.

Some key points to consider in the management of acute pancreatitis include:

• The severity of the disease, which can be classified using the 2012 revision of the Atlanta classification and definitions based on international consensus 1
• The need for close monitoring of vital signs, laboratory values, and assessment for complications such as necrosis, pseudocysts, or organ failure
• The importance of early enteral feeding, which has been shown to be beneficial in reducing complications and improving outcomes 1
• The potential need for intensive care in severe cases, with management of complications like respiratory failure, shock, or renal failure

The typical hospital stay for acute pancreatitis ranges from a few days for mild cases to weeks for severe cases, with discharge appropriate only when pain is controlled on oral medications, the patient can maintain adequate oral intake, and laboratory abnormalities are improving. Hospital admission is necessary to provide the necessary supportive care and monitoring to prevent morbidity and mortality. According to the 2019 WSES guidelines for the management of severe acute pancreatitis, patients with organ failure need an urgent transfer to an ICU, and those with persistent organ failure are at high risk of death 1.

From the Research

Reasons for Hospital Admission

• Acute pancreatitis (AP) is a potentially life-threatening disease that requires intensive care, especially in severe cases 2
• AP remains the most common reason for hospital admission of all the gastrointestinal illnesses in the United States 3
• The management of severe acute pancreatitis (SAP) requires prolonged hospitalization and the expertise of a multidisciplinary team 4

Severity of Acute Pancreatitis

• Patients presenting with severe disease may require intensive care unit (ICU) admission 5
• Factors predicting mortality and morbidity need to be identified for improving outcome 5
• The overall hospital mortality for AP patients requiring ICU admission was 52% 5

Management of Acute Pancreatitis

• The goal of management is to provide recommendations regarding the management of the critically ill patient with SAP 6
• Topics addressed in management include monitoring, prophylactic antibiotics, nutritional support, surgery, and therapy targeting the inflammatory response 6
• Effective management and beneficial patient outcomes depend on continuous interdisciplinary collaboration 4

Importance of Interdisciplinary Collaboration

• A multidisciplinary team is required for the management of SAP, comprising emergency physicians, intensivists, internists, gastroenterologists, visceral surgeons, and experts in nutrition, infectious disease, endoscopy, as well as diagnostic and interventional radiology 4
• Interdisciplinary collaboration is essential for improving outcomes in SAP management 4