Presentation:
Patient could be drinking excessive Alcohol, had history of pancreatitis or cholelithiasis or using medications that could cause pancreatitis, might have had ERCP recently or infections or idiopathic
ER:
Routine Labs
Amylase, Lipase
US of RUQ or CT scan of abdomen
Pain meds
NPO
Aggressive IV Fluids
Hospitalist:
Continue IV fluids upto 125-150ml/hr depending on patient
Bowel rest
Pain Management with Narcotics IV-Morphine/Dilaudid
GI and DVT prophylaxis
Antibiotics ( Imipenem) for necrotizing pancreatitis more than 30%
Lipid panel-if Triglycerides are very high, sometimes patient can end up on Hemodialysis due to severe renal failure.
GI consult-may do ERCP if this is caused by obstruction with gall stones, stricture, sludge etc.
Severe pancreatitis patients need ICU management, TPN for nutrition support
Ranson Criteria gives one point for each Category:
Ranson Criteria:
At Admission During First 48hrs
Age > 55 Hematocrit Drop > 10%
WBC > 16,000 Serum Calcium < 8
Glucose > 200 Base Defecit > 4
LDH > 350 Increase in BUN > 5
AST > 250 Fluid Sequestration > 6L
Arterial PO2 < 60
5 % Mortality risk with < 2 signs
15-20%Mortality with 3-4 signs
40% Mortality with 5-6 signs
99% Mortality with > 7 signs
