GASTROENTEROLOGY ARTICLE OF THE WEEK
April 7, 2005
Vege SS, Baron TH. Management of pancreatic necrosis in severe acute pancreatitis. Clin Gastroentrol Hepatol 2005;3:192-196.
1. Which of the following conditions will classify a patient as having SAP
a. severe epigastric pain
b. hypoxia
c. 4 Ranson’s criteria
d. An enlarged pancreas on CT with mesenteric stranding
e. serum creatinine of 2.3 on admission than normalizes in 48 hrs.
f. paralytic ileus
True or False
2. Mortality from AP with infected necrosis is >25%, with sterile necrosis, mortality is ~10%
3. All cases of SAP are associated with pancreatic necrosis.
4. The use of prophylactic antibiotics that penetrate pancreatic tissue is associated with decreased mortality in SAP is the majority of studies
5. FNA of necrotic pancreatic tissue is indicated in patients who show persistent toxicity without improvement over time
6. Infection in the necrotic pancreas usually develops within 3-5 days after admission.
7. In severe pancreatitis, TPN should be started within 48 hours of admission, and it is superior to enteral feeding.
8. Pancreatic debridment should proceed immediately after FNA confirms infection
9. In patients with a negative FNA who continue to do poorly, a repeat FNA may help detect infection.