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home - Pancreas - Pancreatitis - Acute Pancreatitis Written by Dr Sebastian Zeki

Knows the aetiology of acute pancreatitis Understands the means by
which the condition is diagnosed

Is aware of the risk stratification and prognostic scoring systems such
as Glasgow and Ranson; can apply this to the
management plan for individual patients

Knows the complications of severe attacks and the indications for

Knows how to initiate investigation of patients with recurrent
unexplained attacks of pancreatitis

Shows ability to make early risk stratification and involve multidisciplinary team and/or intensive care staff when appropriate

Collaborates closely with radiological and surgical colleagues where

Transfers patient to a specialist centre in accordance with guidelines



Understands the causes presentation investigation and
management of chronic pancreatitis

Knows the potential value of the various imaging modalities
Recognises the potential of blood and stool tests

Aware of the exocrine and endocrine consequences of the condition
Recognises complications

Knows the value of endoscopic non-invasive (ESWL) and surgical

Can diagnose the condition promptly
Knows possible avenues of treatment both to treat the consequences
of pancreatic insufficiency and to control pain where appropriate

Can recognise complications
Works within multi-disciplinary team and liaises with colleagues in
pain management

Shows empathy with patient and relatives


Acute Pancreatitis

FeedingNG fine in 80%Parenteral if ileus >5 days Severe necrotizing pancreatitis is associated with a high rate of complications (local and systemic) and mortality (17 %). SIRS accounts for nearly one-half of the mortality from severe acute pancreatitis.Local complications from pancreatic necrosis, such as pseudocysts and abscesses, can occur from 24 hours to up to six weeks following the onset of acute pancreatitis and account for many of the deaths that occur two weeks after the onset of acute pancreati-tis. Fluids Pain relief AntibioticsProphylactic if >30% necrosis for 7-14 days only Management of mild acute pancreatitis Monitor bloods/ haemodynamics Management of severe acute pancreatitis Consider ITU admission Identify pancreatic necrosis with CT after 5-10 days of disease Necrosis >30% then perform needle aspirate of suspicious areas If sterile then treat symptomatically and repeat CT if not improving If infected consider appropriate sensitive antibiotics and... Extrapancre-atic complica-tions then for laparotomy , correct complications, debride and drain Diffuse retroperito-neal involvement then consider laparotomy Localised necrosis and infection- consider percutaneous catheter +/- debridement Develops in 20% Apache>8 Management of acute pancreatitis

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