Acute pancreatitis: management update and future directions of pancreatic imaging

Essential management points for AP are: 1. Intravenous fluids and adequate hydration are the mainstay of therapy. Antibiotics are not routinely indicated in most cases. 2. The most reliable marker for diagnosing biliary AP is a greater than threefold elevation of the serum alanine amniotrasferase (ALT), which has a positive predictive value of 95% for biliary acute pancreatitis. 3. Early ERCP with ES for stone extraction and biliary decompression has proved beneficial for patients with biliary pancreatitis and evidence of persistent or progressive biliary obstruction with elevated serum total bilirubin and ALT levels. 4. Most patients with severe necrotizing pancreatitis will need intensive care, imaging, possible fine needle aspiration (FNA) by interventional radiology (IR) if necrosis is present on CT and the patient's condition is worsening. 5. If sterile necrosis is found on the FNA aspirate then conservative therapy would be continued; but if infected necrosis is found, then consideration for surgical consultation is needed for possible surgical therapy with debridement and necreotectomy.