Mnemonic based management of Acute Pancreatitis

Acute pancreatitis along with case based discussion has been already covered earlier here:

To remember the initial management of acute pancreatitis, one can remember the mnemonics given below:

iPA-NCREAS (Ye et.al.)

Investigations:

1. Imaging (CT, MRI or Ultrasonography)
2. Prognostic screen to identify severe pancreatitis
3. Amylase and lipase levels

Initial treatment:

1. Nutritional support
2. Cholecystectomy if suspected/proven gallstone pancreatitis
3. Resuscitation of fluids
4. ERCP within 72 hours of pain onset if gallstone pancreatitis
5. Antibiotics
6. Supplemental oxygen

Another acronym mnemonic based approach has been discussed by Khaliq et.al.

PANCREAS

1. Perfusion:
   • Fluid resuscitation to maintain urine output 0.5-1 ml/kg/hr
   • Oxygenation in order to maintain SpO2 >95% in severe pancreatitis
2. Analgesia: including opioids
3. Nutrition: Enteral feeding within 48 hours (+/- nasojejunal feeding)
4. Clinical: Prognostic scoring e.g. BISAP, RANSON, APACHE-II
5. Radiology:
   • USG: to detect gallstones, choledocholithiasis and local complications
   • CECT: after 48-72 hours of pain onset to determine degree and extent of necrosis
   • Percutaneous catheter drainage guided by USG or CECT is helpful in management of necrosis and as bridging therapy until surgical management
6. ERCP: with 72 hours if cholangitis or severe acute pancreatitis with persistent obstruction
7. Antibiotics: Empirical antibiotics if infection is suspected
8. Surgery: for –
   • MODS with necrosis unresponsive to conservative management and percutaneous drainage
   • Pseudo-aneurysm of surrounding vessels with bleeding
   • Infected necrosis
   • Pancreatic abscess
   • Bowel perforation