Internal Medicine

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

48 Acute Pancreatitis Acute Pericarditis

■Pseudocysts: represent collections of pancreatic enzymes secondary

to ruptured pancreatic duct:

➣Major complications include rupture, hemorrhage, & infection

➣Initially pseudocysts followed conservatively; size monitored

preferably for 4–6 wk w/ abdominal CT

■Drainage indicated for growing or symptomatic pseudocysts, signs

of infection, or hemorrhage; depending on expertise of institution,

drainage can be performed by endoscopy, interventional radiology,

or surgery

■Ascites secondary to ruptured pancreatic duct:

➣Diagnosis established by presence of high levels of amylase &

protein in fluid

➣W/ adequate nutrition, ascites may resolve spontaneously

➣Refer pts w/ persistent ascites to gastroenterologist or pancreatic

surgeon

■Fistulas:

➣May resolve spontaneously w/ adequate nutrition &/or somato-

statin to decrease secretions

➣Closure may require repair by pancreatic surgeon

Acute Pericarditis.....................................

ANDREW D. MICHAELS, MD

history & physical

Signs & Symptoms

■prodrome of fever, myalgia, malaise

■chest pain: pleuritic, sharp, retrosternal, improves when sitting up

■dyspnea

■pericardial friction rub

■distant heart sounds may indicate pericardial effusion

tests

Laboratory

■routine: electrolytes, renal panel, CBC, PT, PTT, ESR

■cardiac enzymes if myocarditis/MI suspected

■blood cultures if bacterial pericarditis suspected

ECG

■early (hours-days): widespread ST elevation and PR depression

■late (days-weeks): diffuse T wave inversions

Echo

■pericardial effusion in 60% of cases