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Acute pancreatitis: Difference between revisions
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After the diagnosis is made, the underlying cause must be sought. This includes a thorough history to look for risk factors, serum triglyceride level, calcium level, and abdominal ultrasound for gallstone. [[Endoscopic ultrasound]] may be used if initial investigations does not reveal the etiology. | After the diagnosis is made, the underlying cause must be sought. This includes a thorough history to look for risk factors, serum triglyceride level, calcium level, and abdominal ultrasound for gallstone. [[Endoscopic ultrasound]] may be used if initial investigations does not reveal the etiology. | ||
=== Severity assessment === | === Severity assessment === | ||
The severity of the pancreatitis must be assessed, both based on clinical assessment and the SIRS score | The severity of the pancreatitis must be assessed, both based on clinical assessment and the SIRS score. High <abbr>[[CRP]]</abbr> (> 100 mg/L) suggests necrotising pancreatitis. Important to note that serum lipase/amylase are not predictors of severity, and so the degree of enzyme elevation does not correlate with the severity of the disease.<section end="clinical biochemistry" /> | ||
<section end="clinical biochemistry" /> | |||
== Treatment == | == Treatment == | ||
Management of acute pancreatitis is conservative and supportive, as it's usually self-limiting. This involves pain control, IV fluids (large amounts), and correction of electrolyte and metabolic abnormalities. Mild (oedematous) pancreatitis is self-limited, and so these measures are usually sufficient, and the patient recovers within a week. Feeding should be initialised early but slowly with a soft diet when the pain is decreasing and the inflammatory markers are improving. In more severe cases, the patient should be nil per os (no oral feeding). | Management of acute pancreatitis is conservative and supportive, as it's usually self-limiting. This involves pain control, IV fluids (large amounts), and correction of electrolyte and metabolic abnormalities. Mild (oedematous) pancreatitis is self-limited, and so these measures are usually sufficient, and the patient recovers within a week. Feeding should be initialised early but slowly with a soft diet when the pain is decreasing and the inflammatory markers are improving. In more severe cases, the patient should be nil per os (no oral feeding). Severe acute pancreatitis (as determined by the presence of [[haemodynamic instability]], [[hypoxaemia]], [[acid-base disorder]], [[altered mental status]], etc.) should be managed in an [[intensive care unit]]. | ||
Patients with severe pancreatitis require <abbr>NPO</abbr> for longer time, and so should receive a nasojejunal or nasogastric tube for feeding (rather than parenteral nutrition) for long-term NPO. ''Up until recently, it was believed that food had to be delivered distally to the sphincter of Oddi to prevent the food from stimulating the pancreas. However, it has recently been established that feeding through nasogastric tube does not stimulate the pancreas either.'' | Patients with severe pancreatitis require <abbr>NPO</abbr> for longer time, and so should receive a nasojejunal or nasogastric tube for feeding (rather than parenteral nutrition) for long-term NPO. ''Up until recently, it was believed that food had to be delivered distally to the sphincter of Oddi to prevent the food from stimulating the pancreas. However, it has recently been established that feeding through nasogastric tube does not stimulate the pancreas either.'' | ||