Acute pancreatitis resident survival guide: Difference between revisions
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===Common Causes=== | ===Common Causes=== | ||
* Gallstones | * [[Gallstones]] | ||
* Alcohol | * Alcohol | ||
* Smoking<ref name="Rebours-2012">{{Cite journal | last1 = Rebours | first1 = V. | last2 = Vullierme | first2 = MP. | last3 = Hentic | first3 = O. | last4 = Maire | first4 = F. | last5 = Hammel | first5 = P. | last6 = Ruszniewski | first6 = P. | last7 = Lévy | first7 = P. | title = Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship. | journal = Pancreas | volume = 41 | issue = 8 | pages = 1219-24 | month = Nov | year = 2012 | doi = 10.1097/MPA.0b013e31825de97d | PMID = 23086245 }}</ref> | * Smoking<ref name="Rebours-2012">{{Cite journal | last1 = Rebours | first1 = V. | last2 = Vullierme | first2 = MP. | last3 = Hentic | first3 = O. | last4 = Maire | first4 = F. | last5 = Hammel | first5 = P. | last6 = Ruszniewski | first6 = P. | last7 = Lévy | first7 = P. | title = Smoking and the course of recurrent acute and chronic alcoholic pancreatitis: a dose-dependent relationship. | journal = Pancreas | volume = 41 | issue = 8 | pages = 1219-24 | month = Nov | year = 2012 | doi = 10.1097/MPA.0b013e31825de97d | PMID = 23086245 }}</ref> | ||
* Pancreatic tumor<ref name="Köhler-1987">{{Cite journal | last1 = Köhler | first1 = H. | last2 = Lankisch | first2 = PG. | title = Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma. | journal = Pancreas | volume = 2 | issue = 1 | pages = 117-9 | month = | year = 1987 | doi = | PMID = 2437571 }}</ref> | * [[Pancreatic tumor]]<ref name="Köhler-1987">{{Cite journal | last1 = Köhler | first1 = H. | last2 = Lankisch | first2 = PG. | title = Acute pancreatitis and hyperamylasaemia in pancreatic carcinoma. | journal = Pancreas | volume = 2 | issue = 1 | pages = 117-9 | month = | year = 1987 | doi = | PMID = 2437571 }}</ref> | ||
* Trauma<ref name="Bleichner-1998">{{Cite journal | last1 = Bleichner | first1 = JP. | last2 = Guillou | first2 = YM. | last3 = Martin | first3 = L. | last4 = Seguin | first4 = P. | last5 = Mallédant | first5 = Y. | title = -Pancreatitis after blunt injuries to the abdomen-. | journal = Ann Fr Anesth Reanim | volume = 17 | issue = 3 | pages = 250-3 | month = | year = 1998 | doi = | PMID = 9750738 }}</ref> | * Trauma<ref name="Bleichner-1998">{{Cite journal | last1 = Bleichner | first1 = JP. | last2 = Guillou | first2 = YM. | last3 = Martin | first3 = L. | last4 = Seguin | first4 = P. | last5 = Mallédant | first5 = Y. | title = -Pancreatitis after blunt injuries to the abdomen-. | journal = Ann Fr Anesth Reanim | volume = 17 | issue = 3 | pages = 250-3 | month = | year = 1998 | doi = | PMID = 9750738 }}</ref> | ||
* Medication such as 5- | * Medication such as [[5-Mercaptopurine]], [[azathioprine]], [[5-DDI]]<ref name="Yi-2012">{{Cite journal | last1 = Yi | first1 = GC. | last2 = Yoon | first2 = KH. | last3 = Hwang | first3 = JB. | title = Acute Pancreatitis Induced by Azathioprine and 6-mercaptopurine Proven by Single and Low Dose Challenge Testing in a Child with Crohn Disease. | journal = Pediatr Gastroenterol Hepatol Nutr | volume = 15 | issue = 4 | pages = 272-5 | month = Dec | year = 2012 | doi = 10.5223/pghn.2012.15.4.272 | PMID = 24010098 }}</ref> | ||
* Hypertriglyceridemia | * [[Hypertriglyceridemia]] | ||
* Post - ERCP | * Post - [[ERCP]] | ||
* Metabolic - Hypercalcemia and hyperphosphatemia | * Metabolic - [[Hypercalcemia]] and [[hyperphosphatemia]] | ||
* Infections | * Infections | ||
| Line 36: | Line 36: | ||
* Idiopathic | * Idiopathic | ||
* Ischaemic necrosis of pancreas from vascular sources such as vasculitis and atherosclerosis | * Ischaemic necrosis of pancreas from vascular sources such as [[vasculitis]] and [[atherosclerosis]] | ||
==Management== | ==Management== | ||
Revision as of 17:08, 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
- Alcohol
- Smoking[1]
- Pancreatic tumor[2]
- Trauma[3]
- Medication such as 5-Mercaptopurine, azathioprine, 5-DDI[4]
- 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 | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| H/o severe abdominal pain, breathing difficulty, hypotension, vomiting, fever, cullen's sign, grey turner's sign | Labs - Sr. Amylase, Sr Lipase, Sr 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 | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Surical 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
- ↑ 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)