Abouassaly – Pancreatitis

Acute pancreatitis management requires a nuanced approach centered on early fluid resuscitation, pain control, and nutritional support. Gallstones remain the primary etiology in the United States, often necessitating intervention through ERCP or cholecystectomy. Diagnosis relies on clinical findings and elevated lipase levels, while imaging is reserved for assessing complications rather than initial diagnosis. Effective care involves moderate fluid resuscitation to prevent organ failure, though clinicians must avoid over-resuscitation to mitigate risks like abdominal compartment syndrome. Prophylactic antibiotics are generally contraindicated, as the condition is primarily a chemical inflammatory process. For severe necrotizing cases, the "step-up" surgical approach—utilizing percutaneous drainage followed by delayed debridement—significantly improves patient outcomes by allowing necrotic tissue to demarcate, thereby reducing the need for high-risk, early open surgery.