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Pancreatitis

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What is covered

This interactive flowchart covers identifying and managing pancreatitis.

Updates

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Short Text

Everything NICE has said on pancreatitis in an interactive flowchart

What is covered

This interactive flowchart covers identifying and managing pancreatitis.

Sources

NICE guidance and other sources used to create this interactive flowchart.
Pancreatitis (2018) NICE guideline NG104
Endoscopic transluminal pancreatic necrosectomy (2016) NICE interventional procedures guidance 567
Percutaneous retroperitoneal endoscopic necrosectomy (2011) NICE interventional procedures guidance 384
Laparoscopic distal pancreatectomy (2007) NICE interventional procedures guidance 204

Quality standards

Quality statements

Effective interventions library

Effective interventions library

Successful effective interventions library details

Implementation

Information for the public

NICE has written information for the public on each of the following topics.

Pathway information

Person-centred care

People have the right to be involved in discussions and make informed decisions about their care, as described in your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.

Your responsibility

Guidelines

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Technology appraisals

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, health professionals are expected to take these recommendations fully into account, alongside the individual needs, preferences and values of their patients. The application of the recommendations in this interactive flowchart is at the discretion of health professionals and their individual patients and do not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.
Commissioners and/or providers have a responsibility to provide the funding required to enable the recommendations to be applied when individual health professionals and their patients wish to use it, in accordance with the NHS Constitution. They should do so in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Medical technologies guidance, diagnostics guidance and interventional procedures guidance

The recommendations in this interactive flowchart represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take these recommendations fully into account. However, the interactive flowchart does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the recommendations, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this interactive flowchart should be interpreted in a way that would be inconsistent with compliance with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

Supporting information

Give people with pancreatitis, and their family members or carers (as appropriate), written and verbal information on the following, where relevant, as soon as possible after diagnosis:
  • pancreatitis and any proposed investigations and procedures, using diagrams
  • hereditary pancreatitis, and pancreatitis in children, including specific information on genetic counselling, genetic testing, risk to other family members, and advice on the impact of their pancreatitis on life insurance and travel
  • the long-term effects of pancreatitis, including effects on the person's quality of life
  • the harm caused to the pancreas by smoking or alcohol.
Advise people with pancreatitis where they might find reliable high-quality information and support after consultations, from sources such as national and local support groups, regional pancreatitis networks and information services.
Give people with pancreatitis, and their family members or carers (as appropriate), written and verbal information on the following about the management of pancreatitis, when applicable:
  • why a person may be going through a phase where no treatment is given
  • that pancreatitis is managed by a multidisciplinary team
  • the multidisciplinary treatment of pain, including how to access the local pain team and types of pain relief
  • nutrition advice, including advice on how to take pancreatic enzyme replacement therapy if needed
  • follow-up and who to contact for relevant advice, including advice needed during episodes of acute illness
  • psychological care if needed, where available (see NICE's recommendations on depression in adults)
  • pancreatitis services, including the role of specialist centres, and primary care services for people with acute, chronic or hereditary pancreatitis
  • welfare benefits, education and employment support, and disability services.
For more guidance on giving information, including providing an individualised approach and helping people to actively participate in their care, see NICE's recommendations on patient experience in adult NHS services.
Tell adults with pancreatitis that NICE has published guidance on patient experience in adult NHS services that will show them what to expect about their care.
NICE has written information for the public on pancreatitis.

Passing information to GPs

Ensure that information passed to GPs includes all of the following, where applicable:
  • detail on how the person should take their pancreatic enzyme replacement therapy (including dose escalation as necessary)
  • that the person should be offered HbA1c testing at least every 6 months and bone mineral density assessments every 2 years.

Lifestyle: alcohol

Advise people with pancreatitis caused by alcohol to stop drinking alcohol.
Advise people with recurrent acute or chronic pancreatitis that is not alcohol-related, that alcohol might exacerbate their pancreatitis.
For guidance on alcohol-use disorders, see NICE's recommendations on assessment for harmful drinking and alcohol dependence.
Offer EUS-guided drainage, or endoscopic transpapillary drainage for pancreatic head pseudocysts, to people with symptomatic pseudocysts (for example, those with pain, vomiting or weight loss).
Consider EUS-guided drainage, or endoscopic transpapillary drainage for pancreatic head pseudocysts, for people with non-symptomatic pseudocysts that meet 1 or more of the following criteria:
  • they are associated with pancreatic duct disruption
  • they are creating pressure on large vessels or the diaphragm
  • they are at risk of rupture
  • there is suspicion of infection.
Consider surgical (laparoscopic or open) drainage of pseudocysts that need intervention if endoscopic therapy is unsuitable or has failed.
Consider referring a person with pancreatic ascites and pleural effusion for management in a specialist pancreatic centre.
Assess people with type 3c diabetes every 6 months for potential benefit of insulin therapy.
For guidance on managing type 3c diabetes for people who are not using insulin therapy, see NICE's recommendations on type 2 diabetes in adults and diabetes in children and young people.
For guidance on managing type 3c diabetes for people who need insulin, see NICE's recommendations on:
For guidance on education and information for people with pancreatitis and type 3c diabetes requiring insulin, see NICE's recommendations on:
For guidance on self-monitoring blood glucose for people with pancreatitis and type 3c diabetes requiring insulin, see NICE's recommendations on:
NICE has published a medtech innovation briefing on Cellvizio confocal endomicroscopy system for characterising pancreatic cysts.

Glossary

endoscopic ultrasound
(characterised by organ failure that resolves within 48 hours (transient organ failure) or local or systemic complications in the absence of persistent organ failure (as defined by the revised Atlanta Classification))
(characterised by single or multiple organ failure that persists for more than 48 hours (persistent organ failure) (as defined by the revised Atlanta Classification))
(diabetes mellitus secondary to pancreatic disease; when this is associated with pancreatitis, the primary endocrine defect is insufficient insulin secretion (the abnormality in type 1 diabetes) rather than insulin resistance (which is characteristic of type 2 diabetes))

Paths in this pathway

Pathway created: September 2018 Last updated: September 2018

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