Sandbox3

Management

Signs & symptoms: severe abdominal pain, breathing difficulty, hypotension, vomiting, fever, cullen's sign, grey turner sign

Hemodynamic stability?

{{{ UNSTABLE}}}

{{{ E02 }}}

Stable

Trans abdominal USG

Labs: BUN, CBC, CXR, HCT, serum amylase, serum lipase, serum triglycerides, sr. creatinine

Diagnostic criteria: Any 2 out of 3 Abdominal pain consistent with disease serum amylase or lipase values > 3 times normal consistent findings from abdominal imaging

Acute Pancreatitis

SIRS?

{{{ yes }}}

{{{ NO }}}

Risk stratification (Marshall scoring)

Lower risk

Higher risk

Admit to medical ward

Admit to ICU

Fluids: Aggressive hydration at 250-500 ml/hr with Ringer's lactate in first 12-24 hrs Reassess within 6 hrs after admission and for next 24-48 hrs Analgesics: Opioids are preferred, Mepridine & Morphine may be used as IV drips/pt. controlled analgesia Nutrition: Immediate oral feeding as soon as pain, vomiting, nausea subside (strong recommendation, moderate quality of evidence).

{{{ J02 }}}

{{{ YES }}}

{{{ NO }}}

{{{ YES }}}

{{{ M02 }}}

{{{ NO }}}

{{{ YES }}}

{{{ NO }}}

{{{ - }}}

{{{ + }}}

• * - Low risk: 1. Absence of organ failure. and/or 2. Absence of local complications
• ** - High risk: 1. Transient organ failure. and/or 2. local complications.

The following recommendations are based on 2013 guidelines for Acute pancreatitis treatment based on recommendations given by American college of gastroenterology.