Acute pancreatitis is sudden inflammation of the pancreas. Most patients have a mild illness and recover within a week, but around one in five develop moderately severe or severe disease with organ failure, infected necrosis and a significant risk of death. Nurses play a key role in recognising deterioration, managing pain and fluids, and supporting nutrition.
Causes
- Gallstones and alcohol are the two commonest causes worldwide.
- Very high triglycerides.
- Medicines (some diuretics, azathioprine, valproate and others).
- After ERCP (endoscopic procedure).
- Hypercalcaemia, trauma, infections (mumps, some viruses), and parasites such as Ascaris in endemic areas.
- Sometimes no cause is found (idiopathic).
Signs and symptoms
- Severe upper abdominal (epigastric) pain, often radiating to the back, sometimes eased by leaning forward.
- Nausea and vomiting.
- Tachycardia, fever, tachypnoea.
- Abdominal tenderness and distension.
- In severe cases: hypotension, low SpO₂, confusion, reduced urine output.
- Rare bruising signs around the umbilicus (Cullen’s) or flanks (Grey Turner’s), suggesting haemorrhagic pancreatitis.
Diagnosis
Usually two of three: typical abdominal pain; serum lipase or amylase at least three times the upper limit of normal; and imaging findings. Ultrasound checks for gallstones. Severity is assessed over the first 48 hours using clinical signs, blood tests and scoring systems; organ failure lasting more than 48 hours defines severe disease.
Nursing priorities
1. Close monitoring
- Regular observations with an early warning score; escalate deterioration promptly. See NEWS2.
- Strict fluid balance, often with a urinary catheter and hourly urine output in moderate/severe cases.
- Blood glucose: the pancreas makes insulin, so hyperglycaemia is common.
- Calcium: hypocalcaemia can occur (watch for tingling, muscle spasms).
- Watch for respiratory distress (ARDS can develop).
2. Fluid resuscitation
Inflammation causes fluid to leak out of blood vessels. Early IV fluids, often Ringer’s lactate, are important, but current guidelines favour goal-directed, moderate fluid therapy rather than very aggressive volumes, which can cause fluid overload. Monitor heart rate, blood pressure, urine output and breathing closely.
3. Pain control
Pain is often severe. Give prescribed analgesia promptly and regularly, frequently including opioids, and reassess. See our guides on pain assessment and opioid safety.
4. Early feeding
The old practice of “resting the pancreas” with prolonged nil by mouth has been replaced. In mild pancreatitis, patients can usually start eating as soon as pain and nausea allow. In severe disease, enteral nutrition (via nasogastric or nasojejunal tube) is preferred over parenteral nutrition because it supports the gut barrier and reduces infection. Antiemetics help.
5. Antibiotics only when indicated
Routine prophylactic antibiotics are not recommended. They’re used for confirmed or strongly suspected infections, such as infected necrosis or cholangitis.
Complications to watch for
- Organ failure: kidneys (AKI), lungs (ARDS), circulation (shock).
- Pancreatic necrosis, possibly infected.
- Fluid collections and pseudocysts.
- Bleeding, thrombosis.
- Alcohol withdrawal: see our alcohol withdrawal guide.
Treating the cause
- Gallstone pancreatitis: cholecystectomy (gallbladder removal) during the same admission or soon afterwards for mild cases, to prevent recurrence. ERCP if there is cholangitis or persistent bile duct obstruction.
- Alcohol: brief intervention, support to stop drinking, referral to services, without judgement.
- Triglycerides: dietary and medical management.
Patient education
- Avoid alcohol completely after alcohol-related pancreatitis.
- Low-fat diet initially if advised; stop smoking.
- Recurrent attacks can lead to chronic pancreatitis, diabetes and malabsorption.
- Seek urgent help for severe abdominal pain, vomiting, fever or jaundice.
Related: The acute abdomen · Recognising shock
Based on NICE NG104 (Pancreatitis), the revised Atlanta classification, and American College of Gastroenterology and IAP/APA guidelines. Educational content: follow local protocols.