Acute Pancreatitis - Diagnosis and Management

90% 10%EpigasticPain

90% 10%

NauseaAnd

Vomiting

50%

50%

PainRadiatingToBack

3%97%Cullen’sSign

3%97%

GreyTurnerSign

AmylaseSensitivity

67-83%

AmylaseSpecificity

85-98%

LipaseSensitivity

82-100%

LipaseSpecificity

82-100%

UltrasoundNondiagnostic

25-35%

MRISensitivity

83%

MRISpecificity

91%

CTSensitivity

78%

CTSpecificity

86%

Grade Findings Score

A Normal pancreas 0

B Focal or diffuse enlargementwithout inflammation

1

C Peripancreatic inflammation 2

D Intrapancreatic or extrapancreatic fluid collections

4

E Gas collections 4

Percent Necrosis Score

0% 0

Less than 33% 2

33-50% 4

50% or more 6

CTSI = Grade Score + Necrosis Score

CTSI of 6 or more is severe pancreatitis

Pancreatitis

Fluids

Pain Control

Antibiotics

Nutrition

DVT

Prophylaxis

Intervention

Pancreatitis

Fluids

Pancreatitis

Fluids

Vital SignsHematocritRenal Function

Pancreatitis

Pain Control

Pancreatitis

Antibiotics

Pancreatitis

Antibiotics

Difficult evaluate sepsisInfected necrosis

- Culture (IR)- Antibiotics

Pancreatitis

Pancreatitis

Nutrition

OralEnteralParenteral (TPN)

Pancreatitis

Nutrition

Early enteralnutrition reducesmortality

Pancreatitis

DVT

Prophylaxis

Pancreatitis

DVT

Prophylaxis

High risk of DVT

Splanchnic thrombosis- 1-24%

Pancreatitis

Aspiration/Drainage

Focused on underlyingcause

Intervention

Pancreatitis

Fluids

Pain Control

Antibiotics

Nutrition

DVT

Prophylaxis

Intervention