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