Pancreatitis

Causes

Diagnosis

1. amylase - non-specific
2. Raise in few hrs , peak in 48hrs , normalises in 3-7days
3. ca nelevated in renal insufficiency, salivary gland diseases, acute appendicitis,cholecystitis, intestinal obstruction or ischemia, and gynecologic diseases, lowering its specificity for pancreatitis.

4. 3 X Lipase is more specific to pancreatic injury

5. ALT elevation indicates Gallstone pancreatitis

Mng '

• Early fluid rescuscitation ⇒ micro & macro vascular fluid supply amd reduce necrosis
  • 2.5 to 4 L of fluid over the first 12 to 24 hours
  • adjust fluids based on Renal and Heart status

NS vs RL

Crystalloids are the resuscitation fluids of choice. NS in large volumes may cause a nongap hyperchloremic acidosis and can worsen pancreatitis, possibly by activating trypsinogen and making acinar cells more susceptible to injury.

• NPO

Prolonged NPO

pronlonged NPO casuse microbial translocation and increase moratlity .after nausea and vomiting stopped start low fat diet and oral meds

• Anti-emetics
• Pain via iv opiods
• Anti-biotics if only the Infection in indicated

Tintinally Pancreatitis