Pancreatitis

Acute Pancreatitis

EMKF

  • Pancreatitis is diagnosed by a combination of clinical features (epigastric pain with radiation to back, nausea/vomiting etc) and diagnostic tests (lipase 3x normal, CT scan)
  • A RUQ US should be performed looking for gallstones as this finding significantly alters management
  • The focus of management is on supportive care. IV fluids, while central to therapy, should be given judiciously and titrated to end organ perfusion
  • BISAP Score (Wu 2008, Papachristou 2010) is a clinical score used to predict mortality from pancreatitis.

  • Patients with mild pancreatitis who are tolerating oral intake and can reliably follow up, can be discharged home

 

Ticking Time Bombs

EMKF

Several of the conditions discussed here can easily be overlooked because they may present, at least initially, with non-concerning symptoms. However, they have the ability to cause serious harm. Remember,

  • Address abnormal vital signs or have a cohesive explanation as to why you are not addressing them.
  • Abnormal vital signs without a clear explanation, as well as vital signs that do not resolve with treatment, should prompt expanded consideration of the patient’s complaint, further investigation, and likely both.
  • Bad things happen and even healthy people get sick.

 

The Pregnant Peritonitis

EMKF

appendix-in-pregnancy

  • The gravid uterus can mask the signs of peritoneal irritation (guarding, rigidity and rebound tenderness) by preventing the inflamed organ from contacting the peritoneum.
  • Due to increased white blood cells that naturally occur during pregnancy, leukocytosis is not helpful in identifying acute pathology.
  • A relative increase in blood volume can delay the development of tachycardia and hypotension in the truly ill patient.
  • Consider appendicitis in the patient complaining of typical signs and symptoms of appendicitis even if confounded by right middle and upper quadrant abdominal pain, pyuria, urinary symptoms and subtle signs of peritonitis.
  • HELLP syndrome is managed with blood pressure control, prevention of seizures, correction of coagulopathy, and delivery of the fetus.
  • Radiological investigations, including abdominal plain films, can be safely undertaken during pregnancy and should always be considered so as to avoid delays and failures in diagnosing potentially life-threatening conditions.

 

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