Which of the following are appropriate management strategies for a patient experiencing an acute pancreatitis attack? (Select all that apply)

Choice A rationale Inserting a nasogastric (NG) tube is appropriate, particularly for patients with severe acute pancreatitis who have significant vomiting, ileus, or abdominal distension. Gastric decompression removes gastric contents and acid, reducing the stimulus for secretin and cholecystokinin release, thereby decreasing pancreatic enzyme secretion and reducing pain. Choice B rationale Initiating a low-fat diet immediately is inappropriate because oral intake should be completely withheld (NPO) during an acute attack to rest the pancreas and prevent stimulation of enzyme release, which would worsen the autodigestion process. Nutritional support, if needed, should initially be provided intravenously. Choice C rationale Administering high-dose steroids is not a standard treatment for acute pancreatitis and can potentially worsen the condition by increasing the risk of infection, hyperglycemia, and possibly pancreatic necrosis. Management focuses on supportive care, pain control, and preventing complications, not immune suppression. Choice D rationale Opioid analgesics, such as hydromorphone or fentanyl, are necessary for effective pain relief in acute pancreatitis because the pain is typically severe and unrelenting, often radiating to the back. Aggressive pain management is a key component of supportive care to minimize patient distress and physiological stress. Choice E rationale Withholding oral intake (NPO, nothing by mouth) is a critical management strategy to minimize the stimulation of the pancreas. Restricting all food and fluid intake prevents the release of pancreatic enzymes, thereby halting the cycle of autodigestion and allowing the inflamed pancreas to begin healing. Choice F rationale Encouraging alcohol consumption is absolutely contraindicated, as alcohol is a major cause of chronic pancreatitis and can trigger or worsen acute attacks by directly damaging acinar cells, increasing enzyme production, and altering sphincter of Oddi function. Complete abstinence is necessary for recovery and prevention. Choice G rationale Administering intravenous fluids is essential for hydration and maintaining hemodynamic stability. Patients are often hypovolemic due to vomiting, fever, and third spacing of fluids, so aggressive IV fluid resuscitation (crystalloids) is critical to combat hypoperfusion and minimize the risk of systemic complications like shock and acute tubular necrosis. .