Pancreatitis: Difference between revisions
From IDWiki
Content deleted Content added
m Text replacement - "Clinical Presentation" to "Clinical Manifestations" |
|||
| Line 1: | Line 1: | ||
== |
==Definition== |
||
* |
*Inflammation of the pancreas |
||
== |
==Etiology== |
||
*'''[[Gallstone]]''' |
|||
* Gallstones |
|||
*'''Alcohol''' |
|||
* Ethanol |
|||
* |
*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 |
|||
** Parasitological |
|||
*** |
***[[Ascariasis]] |
||
*** |
***[[Clonorchiasis]] |
||
*** |
***[[Echinococcus]] |
||
* |
*Autoimmune |
||
** |
**[[SLE]] |
||
** |
**[[Polyarteritis nodosa]] |
||
** |
**[[Crohn disease]] |
||
* |
*Surgery: [[ERCP]] |
||
* |
*[[Hyperlipidemia]] |
||
* |
*[[Hypercalcemia]] |
||
* |
*[[Hypothermia]] |
||
* |
*Emboli/Ischemia |
||
* |
*Drugs |
||
** |
**[[Steroids]] |
||
** |
**[[Azathioprine]] |
||
** |
**[[Furosemide]] |
||
** |
**[[Mercaptopurine]] |
||
** |
**[[Estrogen]] |
||
** |
**[[Methyldopa]] |
||
** |
**H<sub>2</sub> blockers |
||
** |
**[[Valproic acid]] |
||
** |
**[[Antibiotics]] |
||
** |
**[[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 |
||
[[Category:Gastroenterology]] |
[[Category:Gastroenterology]] |
||
Revision as of 13:10, 24 August 2020
Definition
- Inflammation of the pancreas
Etiology
- Gallstone
- Alcohol
- Tumour/Trauma
- Scorpion sting (Trinidadian)
- Microbiological
- Autoimmune
- Surgery: ERCP
- Hyperlipidemia
- Hypercalcemia
- Hypothermia
- Emboli/Ischemia
- Drugs
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
References
- ^ Todd H. Baron, Christopher J. DiMaio, Andrew Y. Wang, Katherine A. Morgan. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis. Gastroenterology. 2020;158(1):67-75.e1. doi:10.1053/j.gastro.2019.07.064.
- ^ Sandra van Brunschot, Janneke van Grinsven, Hjalmar C van Santvoort, Olaf J Bakker, Marc G Besselink, Marja A Boermeester, Thomas L Bollen, Koop Bosscha, Stefan A Bouwense, Marco J Bruno, Vincent C Cappendijk, Esther C Consten, Cornelis H Dejong, Casper H van Eijck, Willemien G Erkelens, Harry van Goor, Wilhelmina M U van Grevenstein, Jan-Willem Haveman, Sijbrand H Hofker, Jeroen M Jansen, Johan S Laméris, Krijn P van Lienden, Maarten A Meijssen, Chris J Mulder, Vincent B Nieuwenhuijs, Jan-Werner Poley, Rutger Quispel, Rogier J de Ridder, Tessa E Römkens, Joris J Scheepers, Nicolien J Schepers, Matthijs P Schwartz, Tom Seerden, B W Marcel Spanier, Jan Willem A Straathof, Marin Strijker, Robin Timmer, Niels G Venneman, Frank P Vleggaar, Rogier P Voermans, Ben J Witteman, Hein G Gooszen, Marcel G Dijkgraaf, Paul Fockens, Eric R Manusama, Mohammed Hadithi, Camiel Rosman, Alexander F Schaapherder, Erik J Schoon. Endoscopic or surgical step-up approach for infected necrotising pancreatitis: a multicentre randomised trial. The Lancet. 2018;391(10115):51-58. doi:10.1016/s0140-6736(17)32404-2.
