What are the two most common etiologies of acute pancreatitis, and what is the initial management priority?

• A. Hypertriglyceridemia and gallstones; early antibiotics
• B. Infection and autoimmune; immediate surgery
• C. Gallstones and alcohol; aggressive IV fluids and pain control
• D. Trauma and drug toxicity; simply observe

Answer: (C)

Pancreatitis is most commonly caused by gallstones and alcohol use. The first priority in treatment is supportive care with aggressive IV fluid resuscitation to correct volume depletion and maintain organ perfusion, paired with effective pain control using IV analgesics. This approach targets the main clinical issues early—pain and the inflammatory response—before addressing the underlying cause. Antibiotics are not routinely given unless there’s evidence of infection, and immediate surgery isn’t part of initial management. After stabilization, management focuses on addressing the etiology (for example, removing a gallstone or pursuing cholecystectomy if gallstone–related) and preventing recurrence.