Acute pancreatitis

Background

Etiology

- alcohol

- gallstone

- drugs- azathioprine, cisplatin, lasix, tetracycline, thiazides, sulfa

- hypercalcemia

- hyperlipidemia

- infection

- pregnancy

- scorpion bite

- trauma

- tumor

Diagnosis

- Elevated lipase (more specific and sensitive than amylase)

Treatment

- "Place the pancreas at rest"

• 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

Local

• Pseudocyst, abscess

Systemic

• Cardiac dysfunction
• Renal failure
• Respiratory failure (due to phospholipase damage to surfactant/ increased cap permeability)
• Shock
• Hypocalcemia (due to sequestration in necrotic fat)
• Hyperglycemia

Prognosis

RANSON CRITERIA

- age >55

- WBC > 16k

- glucose > 200

- LDH > 350

- AST> 250

WITHIN 48 HRS

- hct fall of > 10%

- bun increase > 5

- Ca++ < 8

- 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

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

• If mild case + tolerating clears + no e/o gallbladder etiology then consider

           d/c home

• All other patients should be admitted

Source

6/06 MISTRY

Harwood-Nuss