GASTROENTEROLOGY ARTICLE OF THE WEEK
January 15, 2009
Gardner TB, Swaroop S, et al. Fluid resuscitation in acute pancreatitis. Clin Gastroenterol Hepatol 2008;6:1070-1076
1. Which of the following mechanisms contribute to pancreatic damage during acute pancreatitis
a. Decreased vascular permeability of the pancreatic microcirculation leading to ischemia
b. Influx of inflammatory cells into the pancreatic tissue
c. Capillary vasoconstriction
d. Arterial vasodilation of the celiac and SMA trunks leading to hyperemia
e. Release of TNF α, histamine, IL-1,2 & 6 and other mediators
f. Formation of microthrombi contributing to the ischemic damage
2. Recommended rates of fluid replacement in severe pancreatitis based on expert consensus include
a. 500-1000cc/hr for the first 24 hours
patients with severe volume depletion
b. Signs of mild to moderate volume
depletion with evidence of extracellular fluid loss: 250-350cc/hr
c. Patient with normal blood pressure and admission hematocrit of 39% - 250-350cc.hr
d. Most patients with severe pancreatitis
need 1-2 liters of fluid in the first 24 hours
True or False
3. The efficacy
of aggressive volume resuscitation in decreasing the risk of severe acute
pancreatitis has been validated by human studies
4. Patients with acute pancreatitis are considered as having hemoconcentration on presentation if their hematocrit is > 47%
5. The vast majority of the pancreatic microcirculation feeds the pancreatic acinus instead of the islet cells.
6. Failure of
the admission hematocrit to decrease 24 hours after admission is a strong risk
factor for the development of pancreatic necrosis.
7. The arterial blood supply of the pancreas is derived almost exclusively from the celiac trunk
8. Aggressive
hydration with crystalloids has been shown to prevent pancreatic necrosis in
acute pancreatitis