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Pancreatitis (Complications (Early 1-3d (Hypocalcemia (Saponification…

- - - - Saponification reaction depletes Ca :glass_of_milk:
        
        Dx:
        
        BMP: Ca
        
        ionized Ca
        
        :stars: best for prog: BUN for some reason :shrug::skin-tone-2:
        
        Tx: replete Ca
        
        :pencil2:Scoring system: use Ranson's calculator to determine prognosis, but its intuitive. Pt not doing well initially has worse outcomes
  - - - Dx:
        
        Pleural effusions: CXR
        
        Ascites: US
        
        Tx: :warning: do not tap :forbidden: unless you suspect infection
    - - Dx: Necrosis on CT :radioactive_sign:
        
        :warning:f/u w/ biopsy before ABX
        
        Tx: Meropenem, then change according to BCx and sensitivities
  - - - Abscess :volcano:
        
        Pt: SIRS
        
        Dx: CT :radioactive_sign:
        
        Tx: Drain
        
        Abx
      - Pseudocyst
        
        :pencil2: not epithelial, pocket of fluid, mass effect: SBO, early satiety, abn fullness
        
        Dx: CT :radioactive_sign:
        
        Tx: 6&6 rule
        
        < 6cm & < 6wks old = watch and wait :watch:
        
        6cm or >6wks old = Drain w/ biopsy
- - - - :pencil2:Amylase P is a modern, more specific test to pancreatitis
    - - :warning:US is a bad test: bad resolution.
        
        But if gallstones are the culprit, it can diagnose the cause of pancreatitis
        
        :pencil2::warning:CT when enzymes aren't elevated, but you still know its pancreatitis (clinical picture) or is complicated pancreatitis
        
        :pencil2:MRCP doesn't have risk of contrast use. Bad for diagnosis pancreatitis, but good for visualizing strictures (etiology)
        
        :pencil2:Can use ERCP if US shows gallstone pancreatitis (currently).
        
        see dilated ducts
        
        bilirubin remains elevated
      - :warning::forbidden:Early Refeeding? Thought to improve outcomes, No evidence. Feed On Demand.
        
        :warning:Empiric Antinbiotics. Ineffective.
        
        very specific conditions for use. Meropenem > Cipro
- - - - :pencil2:Trauma can cause Retroperitoneal Hematoma.
        
        Dx via
        
        Cullen sign
        
        Turner sign
        
        (pathognmonic for pancreatitis)
        
        Turn onto side: Flank hematoma
        Umbili-Cus: Umbilical Hematomas