GASTROENTEROLOGY ARTICLE OF THE WEEK
February 3, 2005
Tenner S. Initial Management of Acute Pancreatitis: Critical Issues During the First 72 Hours. Am J Gastroenterol 2004;99:2489-94
1. Good markers to identify gallstone pancreatitis include
a. ultrasound on admission
b. AST or ALT elevated > 3x ULN in acute pancreatitis
c. Serum bilirubin >1.35mg/dl on day 2 of admission
d. Rising bilirubin or transaminases within 24-48 hr from admission
e. RUQ pain
True or False
2. Urinary TAP (trypsinogen activation peptide), when high, identifies cases of severe pancreatitis within 12 hours of admission, a negative test almost guarantees mild disease.
3. The amount of pancreatic necrosis on initial CT correlates with the likelihood of developing organ failure.
4. And admission Hct >47% and/or failure of the admission Hct to decrease by 24 hours may predict severe pancreatitis
5. TPN, when started early in acute pancreatitis, has been found to be effective
6. A 3mm gallstone with a 0.4 mm CBD in a 78 y/o patient with severe pancreatitis, normal ALT, AST and bilirubin requires immediate ERCP.
7. 12 hours after admission, a patient has 14,000 WBC, temperature of 101.2, pancreatic necrosis on CT. The most likely explanation is that he has infected pancreatic necrosis
8. Nasogastric enteral feeding may be as safe and nasojejunal enteral feeding for severe acute pancreatitis.
9. A patient with pancreatic necrosis noted on a CT done 24 hours after admission for severe pancratitis who has a temperature of 101.0 and abdominal pain should undergo FNA.