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1. When a diagnosis of acute pancreatitis is made, repeated severity assessments should be carried out at diagnosis, and within 24h, and 24–48 h after diagnosis based on the Japanese Severity Score.
2. For patients with severe acute pancreatitis, transfer to an appropriate medical facility should be considered within 3h after diagnosis has been made.
3. For patients with acute pancreatitis, causes of pancreatitis should be differentiated within 3h after diagnosis, using medical records, hematological examination and imaging studies.
4. For gallstone-induced pancreatitis, early ERCP/ ES should be considered in patients with accompanying cholangitis and/or prolonged passage disorder of the biliary tract including the occurrence or aggravation of jaundice.
5. At a medical facility where treatment for severe acute pancreatitis is performed, abdominal contrast-enhanced CT studies should be performed within 3h after initial treatment. A non-enhanced area and the extent of the disease should be examined, and severity should be assessed on the basis of the CT grades of acute pancreatitis.
6. For acute pancreatitis, sufficient amounts of fluid replacement and monitoring should be performed within 48h of onset, and mean arterial pressure: diastolic blood pressure+(systolic blood pressure-diastolic blood pressure)/3 should be maintained at 65mmHg or more and urinary output at 0.5ml/kg per h or more, respectively.
7. Pain control should be provided for acute pancreatitis.
8. Prophylactic wide-spectrum antibiotics should be administered for severe acute pancreatitis within 72h of onset.
9. Even if intestinal peristalsis is not present, enteral nutrition should be started in small amounts (jejunal administration is desirable) within 48h of diagnosis.
10. Cholecystectomy should be performed after the subsiding of symptoms of pancreatitis for gallstone-induced pancreatitis accompanied by cholecystolithiasis.
CT indicates computed tomography; ERCP, endoscopic retrograde cholangiopancreatography; ES, endoscopic sphincterotomy
