NS 844-Acute pancreatits #2
The most common test for acute pancreatitis
Amylase and lipase are the most common lab test to diagnose acute pancreatitis The amylase and lipase rise 6-12 hours after the onset of symptoms The lipase rises in 8 hours and can persist for 2 weeks
What condition of pancreatitis may show an increase of amylase and lipase
Amylase and lipase is not always elevated in individuals with chronic pancreatitis related to alcohol or hypertriglyceridemia
Although jaundice is rare with acute pancreatitis, what is the cause
Jaundice in acute pancreatitis is associated with compression of the common bile duct by edema or a mass of the head of the pancreas
Is antibiotic therapy necessary for acute pancreatitis
No, because it has not been shown to prevent pancreatic infection If the patient develops a secondary infection later on or suspected pancreatic necrosis infection, then antibiotics can be used
The diagnosis of acute pancreatitis can only be made if
The patient meets at least 2 of the 3 revised Atlanta classification criteria
The treatment of acute pancreatitis is
GI consult Hospitalization for all patients for large volume of IV fluids, lab monitoring, frequent assessment of vital signs, Nutrition and surgical consult may be needed The only exception is mild acute pancreatitis post-ERCP if the patient is able to maintain oral hydration and oral analgesics at home
Complications of acute pancreatitis include
ARDS- Pleural effusions- GI bleeding/hemorrhage- Acute renal failure- Sepsis-Systemic inflammatory response-death hypocalcemia Metabolic abnormalities Blindness (Purtscher retinopathy) Pseudocyst Necrosis Hemorrhage Multisystem organ failure
More severe symptoms seen with necrotizing pancreatitis
Cullen's sign Grey-Turner sign Polyarthritis Erythematous skin nodules
The elevation of what labs should raise suspicion of biliary obstruction (Common presentation of biliary pancreatitis)
Elevated bilirubin and alkaline phosphatase, with or without the presence of elevated aminotransferases, should raise the suspicion for biliary obstruction
When is it appropriate for a patient with pancreatitis to have a CT scan or Endoscopic Ultrasound (EU)
Patients with unexplained pancreatitis who are older than 40 years old because they are at increased risk for pancreatic malignancy and should have further imaging CT or EU
What diagnostic test are done with acute pancreatitis
Serum amylase and lipase Liver enzymes BUN, creatinine electrolytes, blood glucose CBC, CRP, LDH blood gases if indicated by severity Imaging is dependent upon severity or if not sure of the differential, may guide intervention
Patient education for acute pancreatitis
Severe abdominal pain with or without radiation, nausea, vomiting, diarrhea, or diaphoresis requires immediate intervention Educate regarding the risk of repeated attacks of pancreatitis, the need to avoid certain things and the importance to stick to prescribed treatment Educate regarding alcohol use, low fat diet, weight loss, exercise, medications needed and meds to be avoided, and normal trigylcerides
The Atlanta classification criteria for acute pancreatitis
Symptoms and characteristics of acute pancreatitis The serum lipase and amylase is 3X's the normal limit Radiographic findings consistent with pancreatitis
Why is an ultrasound ordered in acute pancreatitis
US is ordered for patients with acute pancreatitis to evaluate for biliary etiologies and gallstones
When does the amylase return to normal in acute pancreatitis
within 3-5 days and the lipase increase can persist for up to 2 weeks