Pancreatitis: Difference between revisions

Revision as of 13:37, 24 August 2020

Definition

Inflammation of the pancreas

Etiology

Gallstone
Alcohol
Tumour/Trauma
Scorpion sting (Trinidadian)
Microbiological
- Viral: Mumps, Rubella, Varicella, Viral hepatitis, CMV/EBV/HIV, Coxsackievirus/Echovirus/Adenovirus
- Bacterial: Mycoplasma, Campylobacter, Mycobacterium tuberculosis, Mycobacterium avium intracellular, Legionella, Leptospirosis
- Parasitic: Ascariasis, Clonorchiasis, Echinococcus
Autoimmune: SLE, Polyarteritis nodosa, Crohn disease
Surgery: ERCP
Hyperlipidemia
Hypercalcemia
Hypothermia
Emboli/Ischemia
Drugs
- Steroids
- Azathioprine
- Furosemide
- Mercaptopurine
- Estrogen
- Methyldopa
- H₂ blockers
- Valproic acid
- Antibiotics: ampicillin, penicillin, ceftriaxone, isoniazid, macrolides, metronidazole, nitrofurantoin, rifampin, sulfonamides, tetracyclines
- Antivirals: didanosine, interferon/ribavirin, nelfinavir, ritonavir
- Antifungals: 5-fluorouracil, pentamidine, stibogluconate
- Acetaminophen
- Salicylates
- Methanol
- Organophosphates

Clinical Manifestations

Acute abdominal pain, usually epigastric, sometimes radiating to the back
Nausea, vomiting
Fevers
Dyspnea

Management

Pancreatic necrosis

Two forms
- Acute necrotizing pancreatitis, which is present at the start, and is usually phlegmonous
- Walled-off necrosis, which develops over the course of illness, and is usually an organized collection
Both are sterile and both can become infected
No antibiotics warranted in acute necrotizing pancreatitis
Infection usually develops after about 10 days
If necrosectomy is indicated, it should be delayed by at least 4 weeks

Splenic vein thrombosis

Monitor

Prognosis

Ranson's criteria

On presentation
- Sugar > 10
- WBC > 16k
- Elderly > 55 years
- LDH > 350
- AST > 250
After 48h
- Hct drop >10% from admission
- BUN increase >5 mg/dL (>1.79 mmol/L) from admission
- Ca <8 mg/dL (<2 mmol/L) within 48 hours
- Arterial pO2 <60 mmHg within 48 hours
- Base deficit (24 - HCO3) >4 mg/dL within 48 hours
- Fluid needs > 6L within 48 hours

BISAP

BUN > 8.9
Impaired LOC
SIRS
Age > 60
Pleural effusion

@@ Line 10: / Line 10: @@
 *Scorpion sting (Trinidadian)
 *Microbiological
+**Viral: [[Mumps]], [[Rubella]], [[Varicella]], [[Viral hepatitis]], [[CMV]]/[[EBV]]/[[HIV]], [[Coxsackievirus]]/[[Echovirus]]/[[Adenovirus]]
-**Viral
+**Bacterial: [[Mycoplasma]], [[Campylobacter]], [[Mycobacterium tuberculosis]], [[Mycobacterium avium intracellular]], [[Legionella]], [[Leptospirosis]]
-***[[Mumps]]
+**Parasitic: [[Ascariasis]], [[Clonorchiasis]], [[Echinococcus]]
-***[[Rubella]]
+*Autoimmune: [[SLE]], [[Polyarteritis nodosa]], [[Crohn disease]]
-***[[Varicella]]
-***[[Viral hepatitis]]
-***[[CMV]]/[[EBV]]/[[HIV]]
-***[[Coxsackievirus]]/[[Echovirus]]/[[Adenovirus]]
-**Bacterial
-***[[Mycoplasma]]
-***[[Campylobacter]]
-***[[Mycobacterium tuberculosis]]
-***[[Mycobacterium avium intracellular]]
-***[[Legionella]]
-***[[Leptospirosis]]
-**Parasitic
-***[[Ascariasis]]
-***[[Clonorchiasis]]
-***[[Echinococcus]]
-*Autoimmune
-**[[SLE]]
-**[[Polyarteritis nodosa]]
-**[[Crohn disease]]
 *Surgery: [[ERCP]]
 *[[Hyperlipidemia]]
@@ Line 46: / Line 28: @@
 **H<sub>2</sub> blockers
 **[[Valproic acid]]
+**[[Antibiotics]]: [[ampicillin]], [[penicillin]], [[ceftriaxone]], [[isoniazid]], [[macrolides]], [[metronidazole]], [[nitrofurantoin]], [[rifampin]], [[sulfonamides]], [[tetracyclines]]
-**[[Antibiotics]]
+**[[Antivirals]]: [[didanosine]], [[interferon]]/[[ribavirin]], [[nelfinavir]], [[ritonavir]]
+**[[Antifungals]]: [[5-fluorouracil]], [[pentamidine]], [[stibogluconate]]
 **[[Acetaminophen]]
 **[[Salicylates]]