Executive summary
Acute pancreatitis is a medical emergency. In primary care, the correct move is usually urgent hospital assessment rather than outpatient work-up. Typical presentation: severe epigastric pain radiating to the back, nausea/vomiting, and systemic unwellness.
Recognise and escalate (don’t delay)
- Suspect pancreatitis in severe epigastric pain (often constant), worse after eating, radiating to the back, with vomiting.
- High-risk context: gallstones/biliary colic history, heavy alcohol use, hypertriglyceridaemia, certain drugs.
- Red flags: hypotension, tachycardia, fever, confusion, jaundice, or severe tenderness/guarding → 999/ED.
Immediate primary care actions (if awaiting transfer)
- Arrange urgent admission (ambulance if unstable).
- Keep nil by mouth if vomiting/severe pain (hospital will manage fluids/nutrition).
- Provide appropriate analgesia and antiemetic if safe and within your setting.
- Document alcohol intake, biliary symptoms, medications, and prior episodes — this helps inpatient work-up.
Cause clues (what to include in handover)
- Gallstones: RUQ pain episodes, jaundice, abnormal LFTs.
- Alcohol: sustained high intake or binges.
- Metabolic: hypertriglyceridaemia, hypercalcaemia (rare).
- Drugs: azathioprine, valproate, thiazides, GLP-1 agents (rare; discuss if suspected).
FAQ
Transparency
This page is an educational, clinician-written summary of publicly available NICE guidance intended for trained healthcare professionals. It uses original wording (not copied text) and should be used alongside the full NICE source, local pathways, and clinical judgement. Doses provided are for general reference; always check the BNF/SPC.