Acute Pancreatitis: The Daily PANCE Blueprint

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Acute Pancreatitis: The Daily PANCE Blueprint

A 45-year-old woman with known gallstones presents with severe, constant epigastric pain radiating to the back, with nausea and vomiting. Lipase is 5 times the upper limit of normal. After the diagnosis is made, what is the most appropriate initial step in management?

A. Urgent ERCP
B. Broad-spectrum IV antibiotics
C. Aggressive IV crystalloid fluid resuscitation
D. Immediate laparoscopic cholecystectomy
E. Bowel rest with oral analgesia alone

Answer and topic summary

The answer is C. Aggressive IV crystalloid fluid resuscitation.

Early aggressive isotonic crystalloid resuscitation (often lactated Ringer’s) is the cornerstone of acute pancreatitis care and reduces morbidity. Prophylactic antibiotics are not recommended for uncomplicated, non-infected pancreatitis; ERCP is reserved for concurrent cholangitis or persistent biliary obstruction; and for gallstone pancreatitis, cholecystectomy is done during the same admission after the patient recovers, not emergently. Diagnosis requires 2 of 3: characteristic pain, lipase/amylase > 3× ULN, or characteristic imaging.

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Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒ Pancreatic Disorders ⇒ Pancreatitis (acute and chronic)

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