ROSH Gastrointestinal Practice Exam

In a case of severe acute pancreatitis, what is the general approach to patient management?

1. Start immediate surgery

2. Provide total parenteral nutrition

3. Hydration and pain control

4. Begin long-term medication therapy

The correct answer is: Hydration and pain control

In managing severe acute pancreatitis, the primary focus is on hydration and pain control. Patients suffering from this condition often exhibit significant fluid shifts and may be at risk for hypovolemia due to aggressive inflammatory processes and potential third spacing of fluid. Therefore, aggressive intravenous fluid resuscitation is crucial to maintain adequate circulating blood volume and renal perfusion. Pain control is equally important, as severe pain is a hallmark of acute pancreatitis. Effective analgesia not only improves the patient’s comfort but also reduces stress and can help mitigate further physiological deterioration. While other options like immediate surgery, total parenteral nutrition, or long-term medication therapy may play roles in the management of pancreatitis under certain circumstances, they are not the first-line approaches in cases of initial management. Immediate surgery is generally reserved for complications like necrotizing pancreatitis or abscess formation. Total parenteral nutrition is considered when a patient requires nutritional support but is not generally initiated immediately. Long-term medication therapy is typically not indicated at the onset of acute pancreatitis; rather, it may be necessary once the patient has stabilized and the underlying causes are addressed. Therefore, the cornerstone of initial management remains hydration and pain control.