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