GASTROENTEROLOGY ARTICLE OF THE WEEK
August 12, 2010
Wu BU, Conwell DL. Acute pancreatitis part I: Approach to early management. Clin Gastroenterol Hepatol 2010;8:410-416.
1. On the 3rd day of admission for acute pancreatitis your patient continues with persistent severe abdominal pain, WBC 16,000, tachycardia and temperature of 101 despite multiple negative cultures. Creatinine is 2.1, despite vigorous resuscitation, no vomiting, no ileus. Next step should include
a. Start prophylactic antibiotics
b. Obtain CT scan without contrast
c. Start TPN through central vein
d. Start enteral nutrition
True or False
2. Amylase but not lipase can be elevated in patients with renal insufficiency
3. Initial resuscitation should include IV fluids at a rate of 60-160cc/kg/24 hours to achieve 0.5 to 1cc/kg/h urine output.
4. Infections developing in the first 2 weeks after admission for acute pancreatitis are usually extra-pancreatic and correlate with increased mortality
5. Patients with uncomplicated pancreatitis can be fed initially with a solid low fat diet instead of clear liquids.
6. An abdominal CT at presentation is highly recommended in patients that present with a typical picture of acute pancreatitis and evidence of SIRS to detect pancreatic necrosis.
7. Infected pancreatic necrosis typically develops on days 4 to 6 of admission
8. Evidence of hemoconcentration (ie. high hematocrit), is the best parameter to predict in-hospital mortality
9. Morphine should be avoided to control pain in acute pancreatitis because it causes sphincter of Oddi spasm.