Current RMA Instruments
| Reasonable Hypothesis SOP | 5 of 2020 |
| Balance of Probabilities SOP | 6 of 2020 |
Changes from previous Instruments
ICD Coding
- ICD-9-CM Codes: 577.0, 577.2
- ICD-10-AM Codes: K85
Brief description
Acute pancreatitis is an acute inflammatory process of the pancreas. The SOP covers (i) single episodes of acute pancreatitis and (ii) recurrent episodes of acute pancreatitis, provided there is no underlying chronic pancreatic disease. Acute on chronic pancreatitis is covered by the chronic pancreatitis SOP.
Confirming the diagnosis
The diagnosis is made based on clinical findings (acute onset of persistent, severe, epigastric pain) and elevation in serum lipase or amylase levels. If the pain is atypical or the lipase or amylase levels not sufficiently elevated, then the diagnosis can still be made if there are characteristic findings of acute pancreatitis on imaging (CT, MRI, or ultrasound).
The relevant medical specialist is a gastroenterologist.
Additional diagnoses covered by SOP
- Pancreatic cyst
- Pancreatic psuedocyst
- Recurrent acute pancreatitis
Conditions not covered by SOP
- Chronic pancreatitis*
- Acute on chronic pancreatitis* - chronic pancreatitis SOP
* another SOP applies
Clinical onset
Time of clinical onset will be based on the first episode of characteristic abdominal pain (confirmed to be pancreatitis by laboratory or imaging results).
Clinical worsening
The only SOP worsening factor is for inability to obtain appropriate clinical management. Most patients have mild disease and recover in three to five days without complications. Around 20 percent have moderately severe or severe acute pancreatitis with local or systemic complications or organ failure. Treatment involves supportive care, with fluid resuscitation, pain control, and nutritional support. Recovery is usual, although severe disease is fatal in some cases. In a small proportion of cases there will be recurrent attacks.