Pancreas

Question 1

How do you treat acute pancreatitis?

Answer 1

NPO → rest pancreas
gradual feeding with low fat diet when free of abdominal pain and bowel sounds return
clear liquids → low fat diet → normal meals
IV fluid resuscitation

Pain control with NSAIDs, tylenol, meperidine
Bedrest
Hydration (LR>NS)

Gallstones = cholecystectomy

Aggressive IV fluids, hemodynamic monitoring in ICU, calcium gluconate if low calcium
+/- PBRC for volume replacement
Vasopressors if persistent hypovolemia
NG tube for nutrition
Post ERCP = rectal indomethacin + IV LR fluids

Surgical consult

Abx if area of necrosis is >30%

Question 2

How do you treat chronic pancreatitis?

Answer 2

Low fat diet, stop ETOH and tobacco use, pain control (NO opioids and NSAIDs) – TCAs, SSRIs, gabapentin, pregabalin
ERCP - dilation + stent
Acid reduction
Treat diabetes
Surgery

Question 3

how do you treat a cyst and abscess?

Answer 3

cyst resolves
abscess - drainage

Question 4

How do you treat pancreatic cancer

Answer 4

Cyst: surgical resection

Beta: surgical resection
Diazoxide while waiting

Adenocarcinoma: surgical resection (only if mets have not made it elsewhere)
Whipple procedure if confined to head or duodenal area
Chemotherapy and radiation
Bile duct stent
Palliative care