Day 5 - Pancreatitis

Defined as: inflammation of the pancreas with biochemical elevation of liver enzymes

Clinical Manifestations: Epigastric pain, nausea, vomitting, anorexia

Common Etiologies: Gallstones, Alcohol induced, Post-ERCP, Hypertriglyceridemia, Hypercalcemia

Investigations: Lipase (recommended over Amylase), liver enzymes, lipid panel with triglycerides, calcium level, abdominal ultrasound

Treatment:

• Supportive care with fluid re-hydration

• Encourage early oral/enteral nutrition

  • Systematic review did not demonstrate any exacerbation of symptoms, and may be improved with shorter hospitalization

• Pain control

• Antibiotics are not recommended during the acute phase of pancreatitis

Complications of Pancreatitis:

• Severe SIRS

• Systemic third spacing, including pleural effusions, pulmonary edema, ascites

  • may cause respiratory distress requiring ICU

• Pancreatic pseudocysts - late complication > 4 weeks

  • May be treated with supportive care or drainage depending on size, speed of growth and symptoms

• Pancreatic Necrosis

  • Areas of necrosis and possible abscess should first be aspirated. Commonly areas of necrosis are sterile and do not need treatment with antibiotic therapy.

• Splanchnic vein thrombosis

  • May not require anticoagulation, hematology consult recommended