Acute Pancreatitis — Management Pathway

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Diagnosis (2 of 3)
   Does it meet the diagnosis (2 of 3)? (Two of three: 1) typical abdominal pain (persistent epigastric/LUQ pain radiating to the back); 2) lipase or amylase >3× ULN; 3) typical findings on imaging (contrast CT/MRI/ultrasound). The first two alone are diagnostic — imaging is not required.)
   • Meets it (≥2) → Severity stratification (revised Atlanta)
   • Does not meet / uncertain → Does not meet / uncertain
2. [End] Does not meet / uncertain
   Diagnosis not established or uncertain: complete the work-up (early contrast CT, repeat enzymes), differentiate other acute abdomens (perforated peptic ulcer, mesenteric ischemia, cholangitis, MI, etc.) and manage along the appropriate pathway.
3. [Decision] Severity stratification (revised Atlanta)
   Severity stratification? (Mild (no organ failure, no local/systemic complications, ~80%); moderately severe (transient organ failure <48 h and/or local complications); severe (persistent organ failure >48 h). On day 1, SIRS, raised BUN, creatinine and hematocrit suggest a tendency to severe disease.)
   • Mild → Mild
   • Moderately severe / severe → Moderately severe / severe
4. [End] Mild
   Moderate goal-directed fluids (2024 ACG: avoid over-resuscitation, prefer lactated Ringer's), analgesia, early oral feeding (as tolerated — no need to fast until enzymes normalize); find the cause (abdominal ultrasound for gallstones); no prophylactic antibiotics. Mild biliary cases: early cholecystectomy during the same admission; ERCP for concurrent cholangitis/obstruction.
5. [End] Moderately severe / severe
   Monitored care (ICU if needed), moderate fluids with close volume assessment (avoid overload complications), analgesia, correct electrolytes; early enteral nutrition (nasogastric preferred over parenteral, lowers infection); antibiotics only for suspected/confirmed infected necrosis or cholangitis; delay surgical/endoscopic/interventional treatment of necrosis/collections to ≥4 weeks (until walled-off), preferring minimally invasive. Find and manage organ failure.

Source guidelines & references

• ACG 2024 Guideline on the management of acute pancreatitis. Am J Gastroenterol 2024
• Revised Atlanta classification (Banks et al.). Gut 2013

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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