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| ==Management==
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| {{familytree/start |summary=Acute Pancreatitis}}
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| {{familytree | | | | | | | | | | | | | A01 | | | | | | | | | | | | | | |A01=<div style="float: left; text-align: left; line-height: 150% ">'''Characterize the symptoms:''' <br> ❑ severe abdominal pain and/or <br> ❑ Breathing difficulty and/or <br> ❑ Nausea & vomiting and/or <br> ❑ Hiccups sometimes </div> }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | A11 | | | | | | | | | | | | | | |A11=<div style="float: left; text-align: left; line-height: 150% ">'''Examine the paient:''' <br> ❑ Fever and/or <br> ❑ Hypotension and/or <br> ❑ [[Cullen's sign]] and/or <br> ❑ [[Grey-Turner's sign]] and/or <br> ❑ Tachypnea and/or <br> ❑ Abdominal distension and/or tenderness</div>}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | A12 | | | | | | | | | | | | | | |A12=<div style="float: left; text-align: left; line-height: 150% ">'''Consider alternative diagnosis:''' <br> ❑ [[Gallstones]] <br> ❑ [[Dissecting aortic aneurysm]] <br> ❑ [[Pancreatic pseudocyst]] </div> }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | E01 |-|-|-|-|-|-|-|-|-|-|-|-|.| | |E01=Hemodynamic stability? }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | |!| |}}
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| {{familytree |border=0 | | | | | | | | | | | | | Z01 | | | | | | | | | | | | Z02 | | | | |Z01 = Stable|Z02= Unstable }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | |!| |}}
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| {{familytree | | | | | | | | | | | | | B01 | | | | | | | | | | | | B03 |
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| B01=<div style="float: left; text-align: left; line-height: 150% ">'''Order Labs: (Urgent)''' <br> ❑ Blood urea nitrogen <br> ❑ CBC <br> ❑ Chest X-ray <br> ❑ Hematocrit <br> ❑ serum amylase <br> ❑ serum lipase <br> ❑ serum triglycerides <br> ❑ serum creatinine
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| ----
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| '''Order imaging studies: (Urgent)''' <br> Trans abdominal USG </div>|B03=Need to create hyperlink here }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | C01 | | | | | | | | | | | | | | |C01=<div style="float: left; text-align: left; line-height: 150% ">'''Diagnostic criteria: Any 2 out of 3''' <br> ❑ Abdominal pain consistent with disease<br> ❑ serum amylase or lipase values > 3 times normal <br> ❑ consistent findings from abdominal imaging </div>}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | D01 | | | | | | | | | | | | | | |D01=Acute Pancreatitis}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | F01 |-|-|-|-|-| F02 |-|.| | | | |F01=Systemic inflammatory response syndrome? '''(Urgent)''' |F02=Yes|"border=0" }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | |!| | | | |}}
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| {{familytree |border=0 | | | | | | | | | | | | | AA1 | | | | | | | | | |!| | | | |AA1=No}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | |!| | | | |}}
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| {{familytree | | | | | | | | | | | | | G01 | | | | | | | | | |!| | | | |G01=Risk stratification (Marshall scoring)'''(Urgent)'''}}
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| {{familytree | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | |!| | | | |}}
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| {{familytree | | | | | | H01 | | | | | | | | | | | | H02 | | |!| | | | |H01=Lower risk |H02=Higher risk}}
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| {{familytree | | | | | | |!| | | | | | | | | | | | | |!| | | |!| | | | |}}
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| {{familytree | | | | | | I01 | | | | | | | | | | | | I02 |-|-|'| | | | |I01= Admit to medical ward |I02=Admit to ICU '''(Urgent)'''}}
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| {{familytree | | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | |}}
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| {{familytree | | | | | | J01 | | | | | | | | | | | | J02 | | | | | | | |J01=<div style="float: left; text-align: left; line-height: 150% "> '''Fluids: (Urgent)''' <br><br> ❑ Aggressive hydration at 250-500 ml/hr with Ringer's lactate in first 12-24 hrs <br> ❑ Reassess within 6 hrs after admission and for next 24-48 hrs
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| '''Analgesics: (Urgent)''' <br><br> ❑ Opioids are preferred <br> ❑ Mepridine & Morphine may be used as IV drips/pt. controlled analgesia
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| '''Nutrition: (Urgent)''' <br><br> ❑ Immediate oral feeding as soon as pain, vomiting, nausea subside </div>
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| |J02=<div style="float: left; text-align: left; line-height: 150% ">'''Fluids: (Urgent)''' <br> ❑ Initiate with a fluid bolus <br> ❑ Aggressive hydration at 250-500 ml/hr with Ringer's lactate in first 12-24 hrs <br> ❑ Reassess within 6 hrs after admission and for next 24-48 hrs
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| '''Analgesics: (Urgent)''' <br> ❑ Opioids are preferred <br> ❑ Mepridine & Morphine may be used as IV drips/pt. controlled analgesia
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| '''Nutrition: (Urgent)''' <br> ❑ Nasogastric or nasojejunal feeding may be initiated once pain, vomiting, nausea subside <br> ❑ Consider enteral feeding if above not tolerated </div>}}
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| {{familytree | | | | | | |`|-|-|-|-|-|-|v|-|-|-|-|-|-|'| | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | K01 |-|-|-|-|-| K02 |-|-|-|-| K03 |K01=Cholangitis or biliary obstruction |K02=Yes |K03=ERCP within 24 hrs/Cholecystectomy to prevent recurrence }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree |border=0 | | | | | | | | | | | | | AK1 | | | | | | | | |AK1=No | | | | | |}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | L01 | | | | | | | | | | | | | | |L01=Consider MRCP/EUS}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | M01 |-|-|-|-|-| M02 |-|-|-|-| M03 |M01=Clinical improvement within 48-72 hrs |M02=Yes |M03=Assess for ability to maintain oral feeding at the end of 1 week}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |!|}}
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| {{familytree |border=0 | | | | | | | | | | | | | AE1 | | | |AE1=N o | | | | | | | | | | |!|}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | |!|}}
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| {{familytree | | | | | | | | | | | | | N01 | | | | | | | | | | | | | N02 | | | | |N01=CECT/MRI |N02=Recovery}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | O01 | | | | | | | | | | | | | | |O01=Pancreatic necrosis}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | P01 |-|-|-|-|-| P02 |-|-|-|-| P03 |P01=Failure to improve clinically after 7-10 days of hospitalization|P02=Yes|P03=Supportive treatment|}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree |border=0 | | | | | | | | | | || | AF1 | | | | |AF1=No | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | Q01 | | | | | | | | | | | | | | |Q01=Suspect Infected necrosis}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | R01 |-|-|-|-| R02 |-|-|-|-| R03 |R01=<div style="float: left; text-align: left; line-height: 150% "> <br> ❑ CT guided FNA
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| ❑ Empiric antibiotics, necrosis penetrating: <br>
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| :: ❑ meropenem 1g IV Q8h <br>
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| :: ❑ ciprofloxacin 400mg IV Q12h plus metronidazole 500 mg IV Q8h for 14 days </div> |R02=Gram stain & Culture (-) |R03=<div style="float: left; text-align: left; line-height: 150% "> ❑ Supportive treatment <br> ❑ Consider repeat CT FNA every 7 days if no improvement </div> }}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree |border=0 | | | | | | | | | | | | | | AG1 | | | | | | |AG1=Gram stain & Culture(+) | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | |!| | | | | | | | | | | | | | | |}}
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| {{familytree | | | | | | | | | | | | | S01 | | | | | | | | | | | | | | |S01=Infected Necrosis}}
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| {{familytree | | | | | | |,|-|-|-|-|-|-|^|-|-|-|-|-|-|.| | | | | | | | |}}
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| {{familytree | | | | | | T01 | | | | | | | | | | | | T02 | | | | | | | |T01=Clinically stable|T02=Clinically unstable}}
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| {{familytree | | | | | | |!| | | | | | | | | | | | | |!| | | | | | | | |}}
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| {{familytree | | | | | | U01 | | | | | | | | | | | | U02 | | | | | | | |U01=<div style="float: left; text-align: left; line-height: 150% "> ❑ Continue antibiotics & observe <br> ❑ If asymptomatic no debridement, else consider surgical consultation </div>|U02=Prompt surgical consultation '''(Urgent)''' }}
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| {{familytree | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |}}
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| {{familytree/end}}
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