Pancreatitis: Difference between revisions
From IDWiki
(→) |
(→) |
||
| (One intermediate revision by the same user not shown) | |||
| Line 10: | Line 10: | ||
*Scorpion sting (Trinidadian) |
*Scorpion sting (Trinidadian) |
||
*Microbiological |
*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]] |
*Surgery: [[ERCP]] |
||
*[[Hyperlipidemia]] |
*[[Hyperlipidemia]] |
||
| Line 46: | Line 28: | ||
**H<sub>2</sub> blockers |
**H<sub>2</sub> blockers |
||
**[[Valproic acid]] |
**[[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]] |
**[[Acetaminophen]] |
||
**[[Salicylates]] |
**[[Salicylates]] |
||
| Line 54: | Line 38: | ||
==Clinical Manifestations== |
==Clinical Manifestations== |
||
| − | *Acute abdominal pain, usually epigastric, sometimes radiating to the back |
+ | *[[Causes::Acute abdominal pain]], usually [[Causes::epigastric pain|epigastric]], sometimes radiating to the back |
| − | *Nausea |
+ | *[[Causes::Nausea]] and [[Causes::vomiting]] |
| + | *[[Causes::Fever]] |
||
| − | *Fevers |
||
| − | *Dyspnea |
+ | *[[Causes::Dyspnea]] |
| + | *Can lead to both endocrine and exocrine dysfunction, including [[diabetes mellitus]] and [[malabsorption]] |
||
| − | == |
+ | === Prognosis === |
| − | === |
+ | ====Ranson's Criteria==== |
| − | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| − | |||
| ⚫ | |||
| − | |||
| ⚫ | |||
| − | |||
| − | ==Prognosis== |
||
| − | |||
| − | ===Ranson's criteria=== |
||
*On presentation |
*On presentation |
||
| Line 93: | Line 62: | ||
**Fluid needs > 6L within 48 hours |
**Fluid needs > 6L within 48 hours |
||
| − | ===BISAP=== |
+ | ====BISAP==== |
*BUN > 8.9 |
*BUN > 8.9 |
||
| Line 100: | Line 69: | ||
*Age > 60 |
*Age > 60 |
||
*Pleural effusion |
*Pleural effusion |
||
| + | |||
| + | == Differential Diagnosis == |
||
| + | |||
| + | * Other causes of [[acute abdominal pain]], including [[peptic ulcer disease]], [[gallstones]], [[cholangitis]], [[cholecystitis]], [[gastrointestinal perforation]], [[intestinal obstruction]], [[mesenteric ischemia]], and [[hepatitis]] |
||
| + | |||
| + | == Diagnosis == |
||
| + | |||
| + | * Made based on the presence of two of the following three criteria: |
||
| + | ** Compatible history |
||
| + | ** Elevated lipase or amylase |
||
| + | ** Characteristic findings on imaging |
||
| + | |||
| + | ==Management== |
||
| + | |||
| + | ===Pancreatic Necrosis=== |
||
| + | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| ⚫ | |||
| + | |||
| ⚫ | |||
| + | |||
| ⚫ | |||
[[Category:Gastroenterology]] |
[[Category:Gastroenterology]] |
||
Latest revision as of 09:41, 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 and vomiting
- Fever
- Dyspnea
- Can lead to both endocrine and exocrine dysfunction, including diabetes mellitus and malabsorption
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
Differential Diagnosis
- Other causes of acute abdominal pain, including peptic ulcer disease, gallstones, cholangitis, cholecystitis, gastrointestinal perforation, intestinal obstruction, mesenteric ischemia, and hepatitis
Diagnosis
- Made based on the presence of two of the following three criteria:
- Compatible history
- Elevated lipase or amylase
- Characteristic findings on imaging
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
