GASTROENTEROLOGY ARTICLE OF THE WEEK
January 18, 2007
Banks PA, Freeman ML. Practice Guidelines in Acute Pancreatitis. Am J Gastroenterol 2006;101:2379-2400
1. Pancreatic necrosis on CT scan is diagnosed when:
a. There is focal or diffuse pancreatic enlargement with heterogeneous enhancement
after IV contrast.
b. Focal well marginated (>3cm) zones of non-enhancement in the pancreas after IV
contrast.
c. Inflammatory changes in the peripancreatic fatty tissue
d. Fluid collections in the pararenal spaces
2. Risk factors that can
be detected at admission and are predictive for severe pancreatitis include;
a. Amylase level >3,000
b. Age >55y
c. Obesity (BMI >30)
d. Diffuse pancreatic edema on CT scan
e. Pleural effusion
3. ERCP in patients with acute pancreatitis should:
a. Be avoided in all cases to prevent worsening of pancreatitis
b. Be performed in all cases of suspected biliary pancreatitis
c. Be done in patients status post cholecystectomy who subsequently develop
gallstone pancreatitis.
d. In all patients with biliary pancreatitis prior to laparoscopic cholecystectomy
e. Be performed in patients with acute pancreatitis and suspected cholangitis
True or False
4. Elevation of pancreatic serum enzymes to levels < 3x ULN, associated with abdominal pain is diagnostic of acute pancreatitis only if the CT scan is abnormal
5. An abdominal CT during the first 24 hours after admission should be obtained in most patients with acute pancreatitis.
6. Abdominal ultrasound is performed soon after admission for acute pancreatitis to assess the degree of pancreatic edema and/or necrosis
7. All patients with evidence of necrotizing pancreatitis should be placed on prophylactic parenteral antibiotics
8. An admission serum hematocrit > 44% and failure of admission of the hematocrit to decrease at 24 hours after admission are very useful predictors of severe pancreatitis
9. A contrasted CT scan performed within 8 hours of admission can reliable distinguish interstitial from necrotizing pancreatitis.
10. Patients with acute pancreatitis who require nutrition support should be given parenteral rather than enteral nutrition.