As you head to google and do a quick search for the GRACE Score, you soon realise the GRACE Score is in fact to calculate the mortality of acute coronary syndrome patients. If only you concentrated in those third year lectures…

But a quick word with your fellow F1 reminds you that there are two possible scoring systems: both the Ranson’s Criteria and the Modified Glasgow Score can be used to predict severity of acute pancreatitis. The Ranson’s Criteria is valid for alcohol-induced pancreatitis, and can only be fully applied after 48h, whereas, the Modified Glasgow Score is validated for pancreatitis caused by gallstones and alcohol. There, the latter would be most useful in Sally’ case.

To treat pancreatitis:

• Nil by mouth, set up IV infusion and provide 0.9% saline
• Provide analgesia – classically pethidine 75-100mg/4h IM, although the concerns around the Sphincter of Oddi spasm are controversial, and many trusts use morphine
• Monitor observations and urine output
• If worsening, consider ITU
• O2 delivery if PaO2 falls
• Find out the cause and correct it, i.e. ERCP and gallstone removal may be needed if there is progressive jaundice.
• CT for assessing extent of pancreatitis/progression/complications