Acute pancreatitis: Difference between revisions

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==Background==
==Background==
===Etiology===
===Etiology===
 
# alcohol
 
# gallstone
- alcohol
# drugs- azathioprine, cisplatin, lasix, tetracycline, thiazides, sulfa
 
# hypercalcemia
- gallstone
# hyperlipidemia
 
# infection
- drugs- azathioprine, cisplatin, lasix, tetracycline, thiazides, sulfa
# pregnancy
 
# scorpion bite
- hypercalcemia
# trauma
 
# tumor
- hyperlipidemia
 
- infection
 
- pregnancy
 
- scorpion bite
 
- trauma
 
- tumor
 


==Diagnosis==
==Diagnosis==
 
# Elevated lipase (more specific and sensitive than amylase)
 
- Elevated lipase (more specific and sensitive than amylase)
 


==Treatment==
==Treatment==
"Place the pancreas at rest"


 
# NPO (clears is probably ok for mild/moderate cases)
- "Place the pancreas at rest"
# IV fluids!
 
# Electrolyte repletion as needed
# NGT if ileus is present
 
# Consider antibiotics for established infection/ severe cases  
* NPO (clears is probably ok for mild/moderate cases)
* IV fluids!
* Electrolyte repletion as needed
* NGT if ileus is present
* Consider antibiotics for established infection/ severe cases  
== ==
 


==Complications==
==Complications==
 
#Local
 
## Pseudocyst, abscess
Local
#Systemic
 
## Cardiac dysfunction
* Pseudocyst, abscess
## Renal failure
Systemic
## Respiratory failure (due to phospholipase damage to surfactant/ increased cap permeability)
 
## Shock  
* Cardiac dysfunction
## Hypocalcemia (due to sequestration in necrotic fat)
* Renal failure
## Hyperglycemia
* Respiratory failure (due to phospholipase damage to surfactant/ increased cap permeability)
* Shock  
* Hypocalcemia (due to sequestration in necrotic fat)
* Hyperglycemia


==Prognosis==
==Prognosis==
 
===RANSON CRITERIA===
 
# age >55
RANSON CRITERIA
# WBC > 16k
 
# glucose > 200
- age >55
# LDH > 350
 
# AST> 250
- WBC > 16k
 
- glucose > 200
 
- LDH > 350
 
- AST> 250
 


WITHIN 48 HRS
WITHIN 48 HRS
 
# hct fall of > 10%
- hct fall of > 10%
# bun increase > 5
 
# Ca++ < 8
- bun increase > 5
# PO2 < 60
 
# base deficit > 4
- Ca++ < 8
# fluid seqeustration > 6L
 
- PO2 < 60
 
- base deficit > 4
 
- fluid seqeustration > 6L
 


0-2= 1% mortallity, 15% for 3-4, 40% for 5-6, 100% for 7 or more signs
0-2= 1% mortallity, 15% for 3-4, 40% for 5-6, 100% for 7 or more signs


===APACHE-II===
# Highest sensitivity and specificity in distinguishing mild from severe pancreatitis
# Can be used to estimate risk of hospital death at admission
# http://www.globalrph.com/apacheii.htm
   
   
APACHE-II
* Highest sensitivity and specificity in distinguishing mild from severe pancreatitis
* Can be used to estimate risk of hospital death at admission
* http://www.globalrph.com/apacheii.htm
==Disposition==
==Disposition==
 
# If mild case + tolerating clears + no e/o gallbladder etiology then consider d/c home
 
# All other patients should be admitted  
 
* If mild case + tolerating clears + no e/o gallbladder etiology then consider
            d/c home
 
 
* All other patients should be admitted  
== ==
 


==Source ==
==Source ==
6/06 MISTRY
6/06 MISTRY


Harwood-Nuss
Harwood-Nuss


[[Category:GI]]
[[Category:GI]]

Revision as of 12:16, 14 March 2011

Background

Etiology

  1. alcohol
  2. gallstone
  3. drugs- azathioprine, cisplatin, lasix, tetracycline, thiazides, sulfa
  4. hypercalcemia
  5. hyperlipidemia
  6. infection
  7. pregnancy
  8. scorpion bite
  9. trauma
  10. tumor

Diagnosis

  1. Elevated lipase (more specific and sensitive than amylase)

Treatment

"Place the pancreas at rest"

  1. NPO (clears is probably ok for mild/moderate cases)
  2. IV fluids!
  3. Electrolyte repletion as needed
  4. NGT if ileus is present
  5. Consider antibiotics for established infection/ severe cases

Complications

  1. Local
    1. Pseudocyst, abscess
  2. Systemic
    1. Cardiac dysfunction
    2. Renal failure
    3. Respiratory failure (due to phospholipase damage to surfactant/ increased cap permeability)
    4. Shock
    5. Hypocalcemia (due to sequestration in necrotic fat)
    6. Hyperglycemia

Prognosis

RANSON CRITERIA

  1. age >55
  2. WBC > 16k
  3. glucose > 200
  4. LDH > 350
  5. AST> 250

WITHIN 48 HRS

  1. hct fall of > 10%
  2. bun increase > 5
  3. Ca++ < 8
  4. PO2 < 60
  5. base deficit > 4
  6. fluid seqeustration > 6L

0-2= 1% mortallity, 15% for 3-4, 40% for 5-6, 100% for 7 or more signs

APACHE-II

  1. Highest sensitivity and specificity in distinguishing mild from severe pancreatitis
  2. Can be used to estimate risk of hospital death at admission
  3. http://www.globalrph.com/apacheii.htm

Disposition

  1. If mild case + tolerating clears + no e/o gallbladder etiology then consider d/c home
  2. All other patients should be admitted

Source

6/06 MISTRY

Harwood-Nuss

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