Question 1

When should I perform CT imaging to assess for local complications?

Accepted Answer

Contrast-enhanced CT is not routinely indicated at presentation unless the diagnosis is uncertain. It should be performed after 72–96 hours if the patient shows signs of severity (persistent organ failure, rising inflammatory markers, or clinical deterioration) to evaluate for pancreatic necrosis.

Question 2

Does the Atlanta classification guide treatment decisions?

Accepted Answer

Yes — the category directs management. Mild pancreatitis usually requires only supportive care and early oral refeeding. Moderately severe pancreatitis may require step-up care, image-guided drainage, or endoscopic necrosectomy. Severe pancreatitis mandates ICU admission, aggressive monitoring, and multidisciplinary management with involvement of interventional radiology and surgery.

Question 3

How is persistent organ failure defined exactly?

Accepted Answer

Persistent organ failure is defined as failure of the same organ system for ≥ 48 consecutive hours. It can affect one or multiple organs. Transient organ failure resolves within 48 hours. The distinction carries major prognostic significance — persistent organ failure is the primary driver of mortality in acute pancreatitis.

Question 4

What about the Determinant-Based Classification?

Accepted Answer

The Determinant-Based Classification (DBC) is an alternative system that further sub-classifies severity based on the presence of infected necrosis. Some centres use DBC alongside or instead of Atlanta. However, the Revised Atlanta Classification (2012) remains the most widely used and guideline-endorsed system internationally.