Acute Pancreatitis - part 1

Acute pancreatitis management has evolved significantly, shifting away from traditional practices like "gut rest" toward evidence-based interventions. Etiologies range from common triggers like alcohol and gallstones to rarer causes such as hypertriglyceridemia and specific medications. While various severity scoring systems exist, clinical observation remains the primary driver of care in practice. Diagnosis requires meeting two of three criteria: characteristic abdominal pain, lipase or amylase levels triple the normal limit, or specific imaging findings. Modern guidelines prioritize early enteral nutrition over total parenteral nutrition (TPN) to prevent bacterial translocation and infection. For mild cases, oral feeding with a low-fat solid diet is safe once pain begins to resolve, while severe cases benefit from either nasogastric or nasojejunal tubes. Notably, elevated pancreatic enzymes alone should not delay feeding, and ERCP is reserved specifically for patients with ongoing biliary obstruction or acute cholangitis.