Severity not proportional to the level of amylase Ranson's Criteria - pancreatitis not due to gallstones (...
Severity
- not proportional to the level of amylase
Ranson's Criteria-
pancreatitis not due to gallstones (criteria slightly different for gallstone-induced pancreatitis)
- at admission
- age> 55
- WBC > 16x 109/L
- blood glucose > 11 mmol/L (with no history of hyperglycemia)
- serum LDH > 350 IU/L
- AST > 250 IU/L
- during first 48 hours
- hematocrit drop > 10%
- BUN rise > 1.8 mmol/L
- arterial PO2< 60 mm Hg
- base deficit > 4 mmol/L
- serum calcium < 2 mmol/L
- estimated fluid sequestration > 6 L
- Interpretation
- difficult course if 2+ present
- high mortality if 3+ present
Differential Diagnosis
- perforated peptic ulcer
- biliary colic
- acute cholangitis, acute cholecystitis
- fatty infiltration of the liver (alcohol)
- small bowel obstruction
- mesenteric infarction
- dissecting aneurysm
- nephrolithiasis
- acute coronary occlusion
Treatment of Acute Pancreatitis
- Goals:
- (1) hemodynamic stability
- (2) alleviate pain
- (3) stop progression of damage
- (4) treat local and systemic complications
- IV crystalloid and NG suction (rests pancreas) if stomach dilated or inflammation severe or patient vomiting
- analgesics to control pain nutritional support (IV), NPO
- no benefit: antibiotics, glucagon, atropine, trasylol, H2blockers, peritoneal lavage
- follow clinically, and with CT/ultrasound to exclude complications
- debride abscesses
- drain pseudocysts if large or persisting or infected
- embolize hemorrhagic vessels
Complications
- pseudocyst (cyst-like structure encapsulated with fibrous material, not epithelium)
- abscess
- lungs: pleural effusion, atelectasis, pneumonia, ARDS
- acute renal failure (ATN)
- CVS: pericardial effusion, pericarditis, shock
