What are key questions to ask a hospitalized patient with acute pancreatitis to assess severity and guide management?

Key Questions to Ask a Hospitalized Patient with Acute Pancreatitis

When evaluating a patient hospitalized for acute pancreatitis, your questions must focus on determining disease severity, identifying the etiology, and detecting complications that affect mortality and morbidity.

Immediate Severity Assessment Questions

Organ Function Status

• Ask about urine output over the past 24 hours - persistent oliguria (<0.5 ml/kg/hour) indicates renal failure and defines severe disease 1, 2
• Inquire about breathing difficulty or shortness of breath - respiratory failure requiring supplementation indicates persistent organ failure 1, 2
• Ask about mental status changes or confusion - may indicate cardiovascular compromise or sepsis 1
• Determine if symptoms have persisted beyond 48 hours - this distinguishes transient from persistent organ failure, which carries 19.8-35.2% mortality 1, 3

Pain Characteristics

• Ask about pain location, radiation, and severity - characteristic epigastric pain radiating to the back supports diagnosis 3, 4
• Determine pain onset timing - helps establish the 48-72 hour window critical for severity assessment 1, 2
• Ask if pain is improving or worsening - clinical deterioration 6-10 days after admission suggests infected necrosis 2

Etiological Assessment Questions

Gallstone Disease

• Ask about prior episodes of right upper quadrant pain or biliary colic - gallstones are the most common cause 1, 4
• Inquire about jaundice, dark urine, or pale stools - suggests biliary obstruction requiring urgent ERCP within 24-72 hours 2
• Ask about previous cholecystectomy - rules out gallstone etiology 1

Alcohol History

• Obtain precise alcohol consumption in units per week - alcohol is the second most common cause 1, 4
• Ask about duration and pattern of alcohol use - chronic use is more relevant than acute intoxication 1
• Determine timing of last alcohol consumption - helps establish causality 1

Medication and Drug History

• Ask about all prescription medications, particularly recent additions - drugs are a notable cause 1, 4
• Inquire about over-the-counter medications and supplements 1
• Ask about corticosteroid use, immunosuppressants, and chemotherapy agents 1

Metabolic Causes

• Ask about history of high cholesterol or triglycerides - hypertriglyceridemia is a notable cause 1, 4
• Inquire about diabetes or thyroid disease - associated with metabolic pancreatitis 1
• Ask about family history of pancreatitis or hyperlipidemia 1

Complication Detection Questions

Signs of Infection

• Ask about fever, chills, or rigors - suggests infected necrosis, which has highest mortality when combined with organ failure 1, 3
• Inquire about new or worsening symptoms after initial improvement - clinical deterioration after day 6-10 indicates complications 2

Nutritional Status

• Ask about ability to tolerate oral intake - inability to eat is an admission criterion 2
• Determine duration of nil-by-mouth status - prolonged fasting requires nutritional intervention 1
• Ask about nausea, vomiting, and abdominal distension - affects feeding strategy 1

Comorbidity Assessment

• Ask about pre-existing heart, lung, or kidney disease - exacerbation defines moderately severe disease 1, 3
• Inquire about obesity or body mass index >30 - independent severity marker 3
• Ask about immunosuppression or HIV status - affects infection risk 1

Previous Episodes and Recurrence Risk

Prior Pancreatitis History

• Ask about previous episodes of pancreatitis - recurrent attacks warrant ERCP to exclude anatomical variants or ampullary tumors 1
• Determine if previous etiology was identified and treated - particularly gallstones requiring cholecystectomy 2
• Inquire about chronic pancreatitis symptoms - affects long-term management 4

Critical Pitfalls to Avoid

• Do not rely solely on pain severity to assess disease severity - abdominal pain may not reflect actual severity 5
• Do not miss the 48-hour window for severity stratification - this is when persistent organ failure becomes apparent and mortality risk is established 1, 2, 3
• Do not overlook biliary symptoms requiring urgent ERCP - cholangitis with pancreatitis requires intervention within 24-72 hours 2
• Do not fail to identify patients needing ICU transfer - those with persistent organ failure require intensive care 1, 2