A 40-year-old woman presents with sudden-onset severe epigastric pain radiating to the back, nausea, and vomiting. Her serum amylase is 1,200 U/L and lipase is 3,400 U/L. CT abdomen shows pancreatic oedema with peripancreatic fat stranding and no necrosis. She is haemodynamically stable. On day 3 of admission her Revised Atlanta criteria suggest mild acute pancreatitis. Which of the following is the single most important intervention in her management?
- A Urgent ERCP with sphincterotomy
- B Aggressive intravenous fluid resuscitation with Ringer's lactate ✓
- C Prophylactic broad-spectrum intravenous antibiotics
- D Emergency cholecystectomy within 24 hours
Explanation
Aggressive early fluid resuscitation (preferably with Ringer's lactate, which is associated with lower rates of systemic inflammatory response syndrome compared to normal saline) is the cornerstone of acute pancreatitis management and reduces the risk of progression to severe disease. Prophylactic antibiotics are not recommended in mild or moderate pancreatitis. ERCP is indicated only when there is concurrent acute cholangitis or persistent biliary obstruction. Cholecystectomy is recommended during the same admission once pancreatitis has resolved, not as an emergency in the acute phase.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.