7/12/16 AM Report – Pancreatitis

Remember the common (and not so common) causes of pancreatitis (I GET SMASHED):

Idiopathic

Gallstones
ETOH
Trauma

Steroids
Mumps
Autoimmune
Scorpion stings (species found on the island of Trinidad)
HyperTG/Ca2+
ERCPs
Drugs
* Gallstones and alcohol account for approximately 80% of all cases in the US

Diagnosis of pancreatitis (requires 2 of 3):

  1. Typical clinical symptoms
  2. Elevated Lipase > 3 x the ULN
  3. Imaging findings consistent with pancreatitis

Clinical predictors of worse prognosis:

  • Older age (usually 55-75 years old)
  • Alcohol – increased risk for pancreatic necrosis and need for intubation
  • Obesity (BMI > 30) OR 2.9
  • Multiple medical co-morbidities

Management Principles:

  1. Fluid Replacement
    • 5-10 mL/kg/hr of isotonic crystalloid solution unless contraindicated 
    • Avoid LR in patients with hypercalcemia since it contains calcium
    • Re-evaluate frequently in the first 6 hours and adjust rate as necessary
  2. Pain Management
    • Typically IV opiates in PCA form
    • Dilaudid/fentanyl are good choices; morphine has been shown to increase sphincter of Oddi pressure, but no studies exist to suggest worse outcomes
  3. Nutrition
    • Oral feeds can be resumed in mild pancreatitis as soon as pain controlled/patient hungry
    • Enteral feeds are preferred over parental feeds; place NJ tube beyond ligament of Trietz if possible – but NG preferred to NPO
  4. Antibiotics
    • prophylactic antibiotics are not recommended regardless of the type (interstitial/narcotizing) or severity (mild/moderate/severe)

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s