What are the treatment and management options for a patient with acute pancreatitis?

Patient Handout: Acute Pancreatitis

What is Acute Pancreatitis?

Acute pancreatitis is inflammation of the pancreas that can range from mild to life-threatening. Most cases (80%) are mild and resolve on their own with supportive care, but 20% can be severe and require intensive monitoring. 1

What Caused My Pancreatitis?

The most common causes are:

• Gallstones (blocking the pancreatic duct) 1
• Alcohol use 2
• High triglycerides (fat in the blood) 3
• Certain medications 3
• Procedures like ERCP 3

Your doctor should identify the cause in at least 80% of cases to prevent future episodes. 1

What to Expect During Your Hospital Stay

If You Have Mild Pancreatitis:

You can start eating immediately if you don't have nausea or vomiting—there's no need to wait. 3, 2 Early feeding actually helps protect your gut and speeds recovery. 4

• You'll receive IV fluids, especially in the first 12-24 hours 3
• Pain control with oral medications 1
• Monitoring of vital signs on a regular hospital ward 1
• No antibiotics unless you develop a specific infection (chest, urine, or IV line infection) 1

If You Have Severe Pancreatitis:

You will be managed in an intensive care unit or high dependency unit with continuous monitoring. 1

• Aggressive IV fluid resuscitation 1, 3
• Feeding through a tube (nasogastric or nasojejunal) if you cannot eat by mouth 1
• IV pain medications 1
• Oxygen support or mechanical ventilation if needed 1
• Close monitoring including hourly vital signs, urine output, and blood oxygen levels 1
• CT scan within 3-10 days to assess for complications 1

Pain Management

• Mild pain: NSAIDs (like ibuprofen) with or without acetaminophen (Tylenol) 5
• Moderate pain: Weak opioids combined with non-opioid pain relievers 5
• Severe pain: Stronger opioids with mandatory laxatives to prevent constipation 5

If Your Pancreatitis Was Caused by Gallstones

You MUST have your gallbladder removed during this hospital stay or within 2 weeks of discharge. 1, 5, 4 Delaying surgery beyond 2-4 weeks dramatically increases your risk of another attack of pancreatitis, which could be fatal. 5, 4

If you have signs of infection in your bile duct (cholangitis—fever, jaundice, abdominal pain), you'll need an urgent ERCP procedure within 24-72 hours to remove stones and open the bile duct. 1, 4

Antibiotics: When Are They Needed?

Routine antibiotics are NOT recommended for acute pancreatitis. 1, 4 They don't prevent complications or reduce mortality. 1, 4

Antibiotics are only given if you develop:

• Documented infection (pneumonia, urinary tract infection, blood infection) 1, 4
• Infected pancreatic tissue (diagnosed by needle aspiration) 1
• Cholangitis (bile duct infection) 1

Nutrition and Diet

Early feeding is beneficial, not harmful. 4, 3, 2

• Start eating as soon as you can tolerate it—you don't need to wait for bowel sounds or passing gas 4, 3
• Low-fat, normal-fat, and solid foods have all been used successfully 4
• If you cannot eat by mouth, tube feeding is preferred over IV nutrition 1
• Tube feeding protects your gut barrier and reduces infection risk 4

When Can I Go Home?

You can be discharged when:

• No organ failure is present 5
• You're tolerating oral intake 5
• Pain is controlled with oral medications 5
• No complications on imaging 5
• The cause has been identified and addressed 5

After Discharge: Critical Warning Signs

Return to the emergency department immediately if you develop:

• Worsening abdominal pain 5
• Fever 5
• Inability to eat or drink 5
• Yellowing of skin or eyes (jaundice) 5
• Difficulty breathing 1

Follow-Up Care

• Schedule a follow-up appointment within 1-2 weeks to ensure complete recovery 5
• If you have gallstones and haven't had surgery yet, this MUST be scheduled within 2 weeks 1, 5, 4
• If alcohol caused your pancreatitis, you should receive alcohol counseling 2
• Never delay gallstone treatment beyond 2 weeks—the risk of fatal recurrent pancreatitis is too high 5, 4

Common Pitfalls to Avoid

• Don't refuse early feeding—eating early helps you recover faster 4, 3
• Don't delay gallbladder surgery—waiting increases your risk of life-threatening recurrent pancreatitis 5, 4
• If prescribed opioids, take the laxatives—opioid-induced constipation is predictable and preventable 5
• Don't assume you're "cured" after discharge—close follow-up is essential 5

Prognosis

• Overall mortality is less than 10% 1
• Mild pancreatitis has less than 5% mortality 1
• Severe pancreatitis has up to 30% mortality 1
• Most patients recover completely with appropriate treatment 1, 3