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Pancreatitis - Coggle Diagram
Pancreatitis
Management
Resuscitation
UO>0.5mls/kg
Hypovalaemia associated with higher rates of necrosis
Analgesia
General supportive care
Thromboporphalaxis
VAP bundle
Head up
Supraglottic suction
Daily sedation holds
PPI
Oral chlorhexidine
Physiotherapy
Nutritional support
enteral feeding decreases infection rates
Complications
5% have psudocyst formation
Pancreatic necrosis
Surgery
Psudocyst
Conservative
Aspiration
Duct disruption
Drainage tube
Abcess
Percutaneous catheter
Necrosis
Necrosectomy
Sterile but 50% will develop infection by weeks 3-4
Early surgery (<2 weeks) associated with high mortaility
Medical
somatostatin
Octreotide
ATLANTA admission criteria
Age >70
Obesity
Ongoing fluid resuscitation
Severe disease
30% pancreatic necrosis
3 ranson criteria
Pleural effusions
CRP>150
Causes
Obstructive
Gallstones
Neoplasia
Cystic fibrosis
Systemic
Ischaemia
Drugs
Steriods
furosemide
Azothiprine
Hypercalcaemia
Parenchymal
Alcohol
Trauma including ERCP
Autoimmune
Severity
Types
Interstiaital oedematous
Necrotising
Scoring systems
Ranson Criteria
At admission and at 48 hours
5 criteria then 6 criteria
Different criteria for gallstone and non -gallstone associated pancreatits
Glasdow (Imrie)
PANCREAS
Pa02
Age
Neutrophils
Calcium
Renal
Enzymes
ALbumin
Sugar
CT Severity Index
Balthezar score
Max 10 = mortaility 17%
Normal
Enlargement
Inflammation of peripancreatic fat
Fluid collection