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Acute pancreatitis (Treatment (Aggressive fluid resus, Treatment of…
Acute pancreatitis
Treatment
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Treatment of underlying cause (ERCP if GS present, withdrawal of offending drugs)
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Jej feeding (safe, feasibile, cheaper and safer than TPN)
Controversial therapies
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Anti secretory drugs (somatostatin, octreotide)
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Scoring systems
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Components (Glasgow - PANCREAS). Each component scores 1 and score of 3 or more indicates severe pancreatitis
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Complications
Associated with systemic inflammatory response (sepsis, myocar depression, ARDS, RF)
Respiratory (pleural effusion, atelectasis)
Metabolic (hypocalcaemia, hyperglycaemia)
Abdominal (Ileus, necrosis, pseudocyst, abscess)
Clinical features
Symptoms - epigastric pain radiating to back, N+V
Signs - local tenderness through to peritonism, systemic inflamm response, associated disorders (jaundice, biliary obstruction), complications (Grey-Turner sign, Cullen's sign) due to retroperitoneal haemorrhage.
Investigations
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Imaging
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Abdominal CT with contrast - confirm diagnosis, look for complications (necrosis, pseudocysts)
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Definition: Severe acute pancreatitis - acute pancreatitis associated with organ dysfunction or local or regional complications (20% of cases, most deaths result form sepsis and multiorgan failure)