Acute pancreatitis resident survival guide: Difference between revisions

Revision as of 17:16, 27 November 2013

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vidit Bhargava, M.B.B.S [2]

Definition

Acute pancreatitis is an acute inflammation of the pancreas characterized by severe abdominal pain and elevated pancreatic enzymes.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Acute pancreatitis from any cause may be life-threatening especially if it progresses to necrotizing pancreatitis. However, in last several years it has come down due to advances in diagnosis and treatment strategies.

Common Causes

Gallstones

Alcohol

Smoking^[1]
Pancreatic tumor^[2]

Trauma^[3]

Medication such as 5-Mercaptopurine, azathioprine, 5-DDI^[4]

Hypertriglyceridemia

Post - ERCP

Metabolic - Hypercalcemia and hyperphosphatemia

Infections

Toxins such as venom of brown recluse spider, certain arachnids etc.

Pregnancy

Idiopathic

Ischaemic necrosis of pancreas from vascular sources such as vasculitis and atherosclerosis

Management

Acute Pancreatitis

Signs & symptoms: severe abdominal pain, breathing difficulty, hypotension, vomiting, fever, cullen's sign, grey turner sign

Check labs - serum amylase, serum lipase, serum triglycerides, abdominal USG, CBC, CECT, MRI

Diagnostic criteria: Any 2 out of 3
Abdominal pain consistent with disease
serum amylase or lipase values > 3 times normal
consistent findings from abdominal imaging

Risk Stratification

Low risk

High risk

General medical ward

ICU

Inititate supportive care
Aggressive fluid resusication with 250-500mL Ringers Lactate per hr during first 12-24 hours.In sever cases give fluid bolus
Mild cases - oral liquid feeds. In moderate to severe cases enteral feeds, nasogastric or nasojejunal feeds are acceptable.

CT scan

Provide adequate analgesia

Pancreatic necrosis

Stones?

Other causes, treat as per cause.

No

Yes

Surgical consult. Emergency cholecystectomy or ERCP within 24 Hrs of admission

Assess in 1 week

SIRS/Organ failure?

Tolerating oral feeds

Not tolerating oral feed

If yes, surgical consultation.Think about CT guided percutaneous aspiration & culture

Recovery

Add nutritional support. COnsider CT scan

Lack of improvement/Worsening of clinical status

References

Template:WikiDoc Sources

↑ Rebours, V.; Vullierme, MP.; Hentic, O.; Maire, F.; Hammel, P.; Ruszniewski, P.; Lévy, P. (2012). "Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship". Pancreas. 41 (8): 1219–24. doi:10.1097/MPA.0b013e31825de97d. PMID 23086245. Unknown parameter |month= ignored (help)
↑ Köhler, H.; Lankisch, PG. (1987). "Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma". Pancreas. 2 (1): 117–9. PMID 2437571.
↑ Bleichner, JP.; Guillou, YM.; Martin, L.; Seguin, P.; Mallédant, Y. (1998). "-Pancreatitis after blunt injuries to the abdomen-". Ann Fr Anesth Reanim. 17 (3): 250–3. PMID 9750738.
↑ Yi, GC.; Yoon, KH.; Hwang, JB. (2012). "Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease". Pediatr Gastroenterol Hepatol Nutr. 15 (4): 272–5. doi:10.5223/pghn.2012.15.4.272. PMID 24010098. Unknown parameter |month= ignored (help)

[Rebours-2012-1] Rebours, V.; Vullierme, MP.; Hentic, O.; Maire, F.; Hammel, P.; Ruszniewski, P.; Lévy, P. (2012). "Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship". Pancreas. 41 (8): 1219–24. doi:10.1097/MPA.0b013e31825de97d. PMID 23086245. Unknown parameter |month= ignored (help)

[Köhler-1987-2] Köhler, H.; Lankisch, PG. (1987). "Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma". Pancreas. 2 (1): 117–9. PMID 2437571.

[Bleichner-1998-3] Bleichner, JP.; Guillou, YM.; Martin, L.; Seguin, P.; Mallédant, Y. (1998). "-Pancreatitis after blunt injuries to the abdomen-". Ann Fr Anesth Reanim. 17 (3): 250–3. PMID 9750738.

[Yi-2012-4] Yi, GC.; Yoon, KH.; Hwang, JB. (2012). "Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease". Pediatr Gastroenterol Hepatol Nutr. 15 (4): 272–5. doi:10.5223/pghn.2012.15.4.272. PMID 24010098. Unknown parameter |month= ignored (help)

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