Internal Medicine

0521779407-01 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 20:45

46 Acute Pancreatitis

Imaging

■Plain chest & abdominal films to exclude perforation or intestinal

obstruction

■US:

➣Detection of inflammation useful in validating diagnosis

➣Determination of presence of biliary tract disease such as

cholelithiasis & choledocholithiasis

■CT:

➣Useful when diagnosis unclear

➣Useful in determining severity & risk of complications: pres-

ence of significant pancreatic necrosis (>50% of gland) predicts

increased risk of mortality & subsequent complications

➣Useful in identifying complications: pseudocyst, fluid collec-

tions, hemorrhage

differential diagnosis

■Gallbladder disease

■Peptic ulcer disease

■Intestinal ischemia

■Intestinal perforation

■Biliary tract disease must be considered in pts w/ jaundice or in-

creased LFTs; possible diseases:

➣Choledocholithiasis

➣Cholangiocarcinoma

➣Bile duct strictures

management

What to Do First

■Initial management should emphasize fluid resuscitation & elec-

trolyte management

■Severe cases require ICU hospitalization to manage fluid & respira-

tory status

General Management

■Analgesics

■Consider treatment w/ antibiotics (eg, imipenem) for severe acute

pancreatitis as determined by clinical staging criteria (Ranson cri-

teria) or abdominal CT revealing extensive necrotizing pancreatitis

(>50% involvement of gland)

■Antibiotic treatment in severe cases may decrease incidence of sub-

sequent sepsis