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Acute pancreatitis
NICE guideline [NG104 ]Published: 05 September 2018 Last updated: 16 December 2020
People with acute pancreatitis usually present with sudden-onset abdominal pain. Nausea and vomiting are often present and there may be a history of gallstones or excessive alcohol intake.
Typical physical signs include epigastric tenderness, fever and tachycardia. Diagnosis of acute pancreatitis is confirmed by testing blood lipase or amylase levels, which are usually raised. If raised levels are not found, abdominal CT may confirm pancreatic inflammation.
Do not assume that a person’s acute pancreatitis is alcohol-related just because they drink alcohol.
If gallstones and alcohol have been excluded as potential causes of a person’s acute pancreatitis, investigate other possible causes such as:
metabolic causes (such as hypercalcaemia or hyperlipidaemia)
prescription drugs
microlithiasis
hereditary causes
autoimmune pancreatitis
ampullary or pancreatic tumours
anatomical anomalies (pancreas divisum).
Do not offer prophylactic antimicrobials to people with acute pancreatitis.
For guidance on fluid resuscitation, see the NICE guidelines on intravenous fluid therapy in adults in hospital and in children and young people in hospital.
Ensure that people with acute pancreatitis are not made ‘nil‑by‑mouth’ and do not have food withheld unless there is a clear reason for this (for example, vomiting).
Offer enteral nutrition to anyone with severe or moderately severe acute pancreatitis. Start within 72 hours of presentation and aim to meet their nutritional requirements as soon as possible.
Offer anyone with severe or moderately severe acute pancreatitis parenteral nutrition only if enteral nutrition has failed or is contraindicated.
Infected necrosis
Offer people with acute pancreatitis an endoscopic approach for managing infected or suspected infected pancreatic necrosis when anatomically possible.
Offer a percutaneous approach when an endoscopic approach is not anatomically possible.
When deciding on how to manage infected pancreatic necrosis, balance the need to debride promptly against the advantages of delaying intervention.
Pseudocysts
For guidance on managing pseudocysts, see the recommendations in the section on pseudocysts in managing complications of chronic pancreatitis.
Pancreatic ascites and pleural effusion
For guidance on managing pancreatic ascites and pleural effusion secondary to pancreatitis, see the recommendation in the section on pancreatic ascites and pleural effusion in managing complications of chronic pancreatitis.
Type 3c diabetes
For guidance on managing type 3c diabetes secondary to pancreatitis, see the recommendations in the section on type 3c diabetes in managing complications of chronic pancreatitis.
If a person develops necrotic, infective, haemorrhagic or systemic complications of acute pancreatitis:
seek advice from a specialist pancreatic centre within the referral network and
discuss whether to move the person to the specialist centre for treatment of the complications.
When managing acute pancreatitis in children:
seek advice from a paediatric gastroenterology or hepatology unit and a specialist pancreatic centre and
discuss whether to move the child to the specialist centre.