Acute pancreatitis

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  1. Etiology: gallstones or alcholism ( account for 80% of cases), medication- induced, hypertriglyceridemia ( >1000 mg/dl), hyperparathyroidism, hypercalcemia, post-ERCP, traumatic, viral, vascular/ischemic.
  2. Symptomatology: severe abdominal pain, nausea, vomiting, anorexia
  3. Signs: fever, tachycardia, hypotension, abdominal tenderness, decreased or absent bowel sounds, abdominal echimoses
  4. Serum amylase and lipase are increased in the first day and return to normal in 3-7 days
  5. See massive sequestration of fluid due to retroperitoneal fluid loss, ileus, and vomiting
  6. Beware of drop in HCT since pancreatitis may hemorrhage
  7. Ranson criteria:
    1. at admission: age >55 yrs, WBC >16,000/cc, AST >250IU/L, glucose >200 mg/dl
    2. during teh initial 48 h: hematocrit falls by >10mg/dl, BUN increase by >5 mg/dl, calcium <8 mg/dl, paO2 <60 mmHg, base deficit > 4 mg/dl, fluid sequestration > 6L.
  8. Treatment:
    1. supportive: fluids, NPO, gastric suction
    2. antibiotics: imipenem, cefuroxime, ciprofloxacine
    3. ERCP, CT-guided aspiration, surgical necrosectomy, debridement, cholecystectomyapr
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