Flashcards in Disorders of the Pancreas Deck (14):
1.Acute onset of upper abdominal pain;
2.Serum amylase or lipase increased by at least 3 times of the upper limit of normal;
3.Characteristic findings on cross-sectional imaging (contrast CT, MRI, or SONO)
1. Abdominal ultrasound is required for every patient.
2.Contrast-enhanced CT is NOT usually required to diagnose acute pancreatitis.
when to use CT scan?
1.Diagnosis is uncertain (pain but minimal pancreatic enzyme elevation)
2.Presentation is severe and concerning for an undiagnosed intraabdominal complication;
3.Patients do not improve within 48-72 hours of hospital admission
1.Elevated serum BUN>20mg/dL
2.Pain control: opioids;
3.Brief bowel rest;
Brief bowel rest
1.Severe pancreatitis-->start within 72 hours;
2.Mild pancreatitis-->start when nausea/vomiting resolve (should not be based on Lipase levels);
Rx if d/t cholelithiasis
1.uncomplicated gallstone pancreatitis-->cholecystectomy should be performed prior to discharge;
2.if ascending cholangitis, ERCP should be performed within 24 hours of presentation
Do not give routine antibiotics;
If does not improved or deteriorates 7-10 days after-->antibiotics-->drain after 4 weeks to make it capsulated.
Pancreatic pseudocysts (interstitial pancreatitis) -->4 weeks;
Walled-off necrosis (pancreatic necrosis) -->4 weeks;
Gastric outlet dysfunction;
Splenic vein thrombosis;
Gastric variceal bleeding;
Rx of pancreatic pseudocysts
usually, resolve on its own;
Rx of Walled-off necrosis
Many resolve on its own;
if symptomatic-->decompression or debridement
1.Exocrine pancreatic insufficiency with bulky and greasy stools;
2.Fat-soluble vitamin deficiency and weight loss;
1. Pain, recurrent attacks of pancreatitis, weight loos;
2. Pancreatic calcification;
3. Ductal dilatation or inflammatory masses;
4. Exocrine pancreatic insufficiency
6. Histology findings.