Of patients with acute pancreatitis, 90 percent recover without complications and require supportive measures only. 1 The general principle is to "rest the pancreas." Although the use of a nasogastric tube is widely advocated, no studies have demonstrated that its presence alters the course of the illness. It is traditionally recommended to withhold all oral intake, but clear liquids do not appear to be harmful in mild to moderate disease.

The mainstay of treatment for acute pancreatitis is fluid resuscitation. A balanced electrolyte solution, such as normal saline, should be administered for rehydration. Amounts should be given to ensure renal perfusion and good urine output of about 100 mL/h. In unstable patients, hemodynamic monitoring may be required, and pressors are indicated for persistent hypotension despite adequate fluid resuscitation.

Other aspects of supportive care include parenteral narcotics and antiemetics.

In biliary pancreatitis, urgent decompression is indicated if there is persistent biliary obstruction, ideally by endoscopic sphincterotomy of the ampulla of Vater. 12 If the obstruction is transient, most patients can be managed with supportive care, and elective cholecystectomy may be performed once inflammation subsides.

Empiric antibiotics are not indicated in mild to moderate pancreatitis but should be given if secondary infection is suspected. Although many other drugs have been used as a potential therapeutic agent in acute pancreatitis, such as H 2 blockers, steroids, nonsteroidal anti-inflammatory drugs, and glucagon, none has demonstrated benefit in controlled, prospective trials.2

Peritoneal lavage may provide short-term clinical improvement but does not appear to alter clinical outcome. Acute fluid collections are rarely symptomatic and frequently resolve spontaneously.16 Laparotomy is indicated for hemorrhage control and abscess drainage. Abscesses and pseudocysts may also be drained radiologically or endoscopically, if indicated.

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