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For the Chapter in the Schwinghammer, Handbook (not Wells Handbook anymore) please go to Chapter 28, Pancreatitis.




  • imageFactors that can contribute to acute pancreatitis should be identified and corrected, including discontinuation of medications that could be potential causes.

  • imagePatients with acute pancreatitis should receive aggressive fluid replacement to reduce the risks of persistent systemic inflammatory response syndrome (SIRS) and organ failure.

  • imageParenteral opioid analgesics are used to control abdominal pain associated with acute pancreatitis despite a lack of high quality evidence to support the practice.

  • imageUse of prophylactic antibiotics is not recommended in patients with acute pancreatitis without signs or symptoms of infection, including those with predicted severe acute pancreatitis or necrotizing pancreatitis.


  • imageChronic pain, malabsorption with resultant steatorrhea, and diabetes mellitus are the hallmark symptoms and complications of chronic pancreatitis.

  • imagePain from chronic pancreatitis may initially be treated with nonopioid analgesics, but adjuvant agents may be necessary as the disease progresses.

  • imagePancreatic enzyme and fat-soluble vitamin supplementation are the primary treatments for malabsorption due to chronic pancreatitis.

  • imageEnteric-coated pancreatic enzyme supplements are the preferred dosage form in the treatment of malabsorption and steatorrhea due to chronic pancreatitis.

  • imageThe addition of a histamine-2 receptor antagonist or proton pump inhibitor to pancreatic enzyme supplementation may increase the effectiveness of enzyme therapy for malabsorption and steatorrhea due to chronic pancreatitis.


Patient Care Process for Pancreatitis



  • Patient characteristics (eg, age, sex, pregnant)

  • Patient history (past medical—hyperlipidemia, recent surgery, gallstone disease or ERCP; social—dietary habits, alcohol use, tobacco use)

  • Current and recent (for acute pancreatitis; see Table 56-2) medications

  • Medication allergies

  • Review of systems for the abdomen and gastrointestinal system (eg, abdominal pain, nausea and vomiting, stool frequency and consistency for chronic pancreatitis; see Tables 56-3 and 56-5)

  • Objective data

    • Acute pancreatitis (see Table 56-3)

      • Vital signs (eg, BP, heart rate, temperature, respiratory rate)

      • Labs (eg, CBC, Chem-7, calcium, albumin, amylase, lipase, transaminases, bilirubin, triglycerides)

      • Microbiology results

      • Intake/output

    • Chronic Pancreatitis (see Table 56-5)

      • Physical exam (eg, weight; assessment for neuropathy, nephropathy, and retinopathy with diabetes)

      • Labs (eg, fasting serum glucose, bilirubin, transaminases, pancreatic function tests, calcium, albumin)


  • Acute pancreatitis

    • Causative medications (see Table 56-2)

    • Nutrition and fluid status

    • Abdominal pain: location, radiation, severity, onset

    • Infectious etiologies

    • Continuous hemodynamic monitoring

  • Chronic pancreatitis

    • Alcohol and tobacco use

    • Abdominal pain

    • Trends in weight, nutrition status, serum glucose, and stool consistency and frequency (assess for constipation if patient taking opioids)


  • Acute pancreatitis

    • Fluid support including choice and dose

    • Discontinue suspected causal medications

    • Nutrition support including route and caloric requirements

    • Pain management with specific medication choice, route, and dose

    • Antimicrobial therapy regimen for suspected or identified infection(s)

  • Chronic pancreatitis

    • Tailored lifestyle modifications (eg, abstinence from alcohol, smoking cessation; see Fig. 56-4)

    • Nutrition support and dietetic counseling

    • Therapy ...

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