Acute Pancreatitis: Management Update

Acute pancreatitis is one of the common gastrointestinal causes of hospitalization worldwide. It is characterized by acinar cell injury with local and systemic inflammatory responses. The presentation ranges from mild, self-limited disease to severe necrotizing pancreatitis with complications of multiorgan failure, leading to high mortality. This chapter reviews current evidence and guideline-based approaches to the diagnosis, risk stratification, and management of acute pancreatitis. It outlines current definitions and severity classifications of acute pancreatitis and highlights the limitations of complex scoring systems in its management. The chapter also underscores the pragmatic use of systemic inflammatory response syndrome (SIRS) criteria and simple tools, such as the Bedside Index for Severity in Acute Pancreatitis (BISAP) score, for early prognostication and management of acute pancreatitis. Evaluation of various etiologies of acute pancreatitis, including biliary, alcohol, metabolic, drug-induced, autoimmune, and idiopathic causes, is discussed, with an evidence-based diagnostic work-up that includes laboratory testing and imaging with ultrasound, magnetic resonance cholangiopancreatography (MRCP), and endoscopic ultrasound. The book chapter outlines key advances in early supportive care for acute pancreatitis, emphasizing moderate, goal-directed fluid resuscitation with balanced crystalloids and timely analgesia. Subsequent sections of the book chapter discuss the logical imaging strategies, the role and timing of endoscopic retrograde cholangiopancreatography (ERCP) in patients with biliary stones, the role of cholecystectomy, antibiotic administration, and minimally invasive step-up approaches for necrotizing pancreatitis. These updates in the management of acute pancreatitis reflect a shift toward less invasive, physiology-guided care that has reduced complications, morbidity, and mortality.