ACG Clinical Guideline 2024
Dr. Scott Tenner
Pancreas
Acute Pancreatitis
Diagnosis, fluid resuscitation, nutrition, and complications management — ACG 2024 Guidelines.
Diagnosis & Etiology
Atlanta criteria, causes, severity
Acute Pancreatitis: Diagnosis & Classification
AP is defined by the revised Atlanta criteria: 2 of 3 must be present for diagnosis.
1
Characteristic abdominal pain
Acute epigastric pain radiating to back
2
Elevated lipase or amylase
≥3× upper limit of normal
3
Imaging findings
CT/MRI consistent with AP
Mild
No organ failure, no local/systemic complications. Resolves within 1 week.
Moderately Severe
Transient organ failure (<48h) OR local/systemic complications without persistent OF.
Severe
Persistent organ failure (>48h) — single or multi-organ. High mortality.
Common Etiologies — Find the Cause!
Gallstones (~40%): Most common — obtain RUQ ultrasound
Alcohol (~30%): History, AST:ALT ratio >2
Hypertriglyceridemia: TG >1000 mg/dL; insulin drip + FFP if severe
Medications: GLP-1 agonists, thiazides, valproic acid, azathioprine
Autoimmune (AIP): IgG4 levels; responds to steroids
Idiopathic: EUS to exclude microlithiasis; consider genetic testing
Tenner SM et al. ACG Clinical Guideline: Management of Acute Pancreatitis. Am J Gastroenterol. 2024.