Pancreatitis: Difference between revisions
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− | == |
+ | ==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 09:10, 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