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ACUTE PANCREATITIS Part 02

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Severity

 

  1. not proportional to the level of amylase

Ranson's Criteria-

 

pancreatitis not due to gallstones (criteria slightly different for gallstone-induced pancreatitis)

  1. at admission
    • age> 55
    • WBC > 16x 109/L
    • blood glucose > 11 mmol/L (with no history of hyperglycemia)
    • serum LDH > 350 IU/L
    • AST > 250 IU/L
  2. during first 48 hours
    • hematocrit drop > 10%
    • BUN rise > 1.8 mmol/L
    • arterial PO2< 60 mm Hg
    • base deficit > 4 mmol/L
    • serum calcium < 2 mmol/L
    • estimated fluid sequestration > 6 L
  3. Interpretation
    • difficult course if 2+ present
    • high mortality if 3+ present

Differential Diagnosis

 

  1. perforated peptic ulcer
  2. biliary colic
  3. acute cholangitis, acute cholecystitis
  4. fatty infiltration of the liver (alcohol)
  5. small bowel obstruction
  6. mesenteric infarction
  7. dissecting aneurysm
  8. nephrolithiasis
  9. acute coronary occlusion

Treatment of Acute Pancreatitis 

 

  1. Goals:
    • (1) hemodynamic stability
    • (2) alleviate pain
    • (3) stop progression of damage
    • (4) treat local and systemic complications
  2. IV crystalloid and NG suction (rests pancreas) if stomach dilated or inflammation severe or patient vomiting 
  3. analgesics to control pain  nutritional support (IV), NPO 
  4. no benefit: antibiotics, glucagon, atropine, trasylol, H2blockers, peritoneal lavage 
  5. follow clinically, and with CT/ultrasound to exclude complications
  6. debride abscesses 
  7. drain pseudocysts if large or persisting or infected 
  8. embolize hemorrhagic vessels

Complications

 

  1. pseudocyst (cyst-like structure encapsulated with fibrous material, not epithelium)
  2. abscess
  3. lungs: pleural effusion, atelectasis, pneumonia, ARDS
  4. acute renal failure (ATN)
  5. CVS: pericardial effusion, pericarditis, shock
ACUTE PANCREATITIS Part 02 ACUTE PANCREATITIS Part 02 Reviewed by Radiology Madeeasy on August 29, 2010 Rating: 5
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