Gastroenterology, surgery and critical care · FICTIONAL CASE

Pancreatitis with organ failure: support, feed and refer

Move beyond analgesia to organ support, appropriate nutrition and early pancreatic-centre advice while avoiding routine prophylactic antibiotics.

Complication recognition and network referral≈ 15 minutes0/3 decisions explored
PAUSE BEFORE USING

This is educational content, not a clinical protocol. Verify current guidance, use local pathways and seek appropriate senior or specialist help.

THE CASE

A fictional 56-year-old with acute pancreatitis develops persistent oxygen requirement, oliguria and hypotension during the first 48 hours.

01 · INITIAL PRESENTATION

Listen for the assumption.

SHO

I planned prophylactic broad-spectrum antibiotics and nil by mouth until the lipase normalised.

Registrar

Neither is routine. We need goal-directed organ support, severity reassessment, enteral nutrition planning and specialist advice for systemic or local complications.

SHO

I will separate sterile inflammation from suspected infection and document the referral threshold.

WHERE IS THE CONSULTANT?

Choose an answer below and reveal the reasoning to see consultant feedback at every checkpoint. The full consultant-led synthesis follows after all three decisions.

Go to the first decision ↓
EVOLVING INFORMATION

The picture develops.

  1. Organ dysfunction persists
  2. No established evidence of infection
  3. Oral intake is limited by vomiting
02 · DECISION CHECKPOINTS

Commit before you reveal.

After you select an option, reveal the model reasoning and the consultant’s feedback.

DECISION 1What is the antibiotic principle?
DECISION 2What is the nutrition priority in severe disease?
DECISION 3What does persistent organ failure trigger?
03 · CONSULTANT-LED SYNTHESIS

Hear the senior team refine the plan.

The registrar tests the plan, the consultant synthesises the key principle, and the SHO confirms the safer next steps.

Registrar

Reassess perfusion and fluid responsiveness carefully, support organs and investigate the cause without assuming alcohol.

Consultant

Correct. Seek network advice for systemic, necrotic, infective or haemorrhagic complications and avoid premature invasive intervention.

SHO

I will hand over organ-failure duration, nutrition, infection evidence and specialist advice.

CLINORA DECISION TRACE
01 · CUEAcute pancreatitis with persistent organ dysfunction
02 · INTERPRETSevere acute pancreatitis
03 · ACTProvide organ support, early enteral nutrition planning and specialist-network escalation
SAFETY CHECK

What must remain explicit.

  • Use current fluid, nutrition and critical-care pathways.
  • Do not prescribe antibiotics solely as pancreatitis prophylaxis.
  • Seek specialist pancreatic-centre advice for systemic or local complications.
COMMON ERRORS

Where reasoning fails.

  • Prophylactic antibiotics
  • Prolonged nil by mouth
  • Referral based only on enzyme concentration
STRUCTURED HANDOVER
Acute pancreatitis caused by [assessment], organ failures [duration/trend], fluid and respiratory support [response], nutrition [plan], infection/necrosis evidence [status] and network advice [details].
REFLECTIVE PAUSE

How quickly can your hospital access its specialist pancreatic referral network?

CONTINUE INTO EXAM PRACTICE

Test the related knowledge.

Move from discussion to MRCP Part 1 questions mapped to the same clinical domains.

Practise Gastroenterology and hepatology →Practise Clinical sciences →