0 calificaciones0% encontró este documento útil (0 votos)
21 vistas31 páginas
This document provides a clinical practice guideline for the management of acute pancreatitis developed by Best Practice in Surgery. It discusses the clinical presentation of acute pancreatitis including symptoms of severe abdominal pain, nausea, vomiting and clinical signs. It outlines the diagnostic criteria including abdominal pain, elevated serum lipase levels and characteristic imaging findings. The document also reviews etiology, assessment tools for prognosis and severity, and management guidelines for treating acute pancreatitis.
This document provides a clinical practice guideline for the management of acute pancreatitis developed by Best Practice in Surgery. It discusses the clinical presentation of acute pancreatitis including symptoms of severe abdominal pain, nausea, vomiting and clinical signs. It outlines the diagnostic criteria including abdominal pain, elevated serum lipase levels and characteristic imaging findings. The document also reviews etiology, assessment tools for prognosis and severity, and management guidelines for treating acute pancreatitis.
This document provides a clinical practice guideline for the management of acute pancreatitis developed by Best Practice in Surgery. It discusses the clinical presentation of acute pancreatitis including symptoms of severe abdominal pain, nausea, vomiting and clinical signs. It outlines the diagnostic criteria including abdominal pain, elevated serum lipase levels and characteristic imaging findings. The document also reviews etiology, assessment tools for prognosis and severity, and management guidelines for treating acute pancreatitis.
ACUTE PANCREATITIS A Clinical Practice Guideline developed by ‘Best Practice in Surgery’
Hassan Bin Ajmal, MBBS
PGY1 General Surgery Resident Surgical Unit – 1 Dr. Ruth K. M. Pfau Civil Hospital Karachi APPROACH CLINICAL PRESENTATON • Pain is the cardinal symptom – severe, develops quickly, reaching maximum intensity within minutes and persists for hours or even days. The pain is constant and refractory to the usual doses of analgesics. Usually starts in epigastrium, may be localized to either upper quadrant or diffuse throughout the abdomen. It may radiate to the back (50%).
• Nausea, repeated vomiting, retching and hiccoughs.
CLINICAL PRESENTATON • A well-looking patient or, at the other extreme, one who is gravely ill with profound shock, toxicity and confusion.
• Tachypnea, tachycardia, and hypotension. The body temperature is
often normal or even subnormal. Signs of SIRS.
• Mild icterus can be caused by biliary obstruction in gallstone
pancreatitis, and an acute swinging pyrexia suggests cholangitis.
• Abdominal examination may reveal distension due to ileus or, more
rarely, ascites with shifting dullness. A mass can develop in the epigastrium due to inflammation. There is usually muscle guarding in the upper abdomen, although marked rigidity is unusual. INVESTIGATIONS DIAGNOSIS 2 of the following (Atlanta Classification 2012):
1. Abdominal pain (acute onset of a persistent,
severe, epigastric pain often radiating to the back).
2. Serum lipase activity (or amylase) at least three
times greater than the upper limit of normal.
3. Characteristic findings of acute pancreatitis on CT
or MRI. Differential Diagnosis
• Perforated Peptic Ulcer
• Acute Cholecystitis • Biliary Colic • Myocardial Infarction Etiology ASSESSMENT Prognostic Criteria (Ranson Score) Severity Assessment (Atlanta criteria) CT Severity Index for Morbidity and Mortality MANAGEMENT GUIDELINES REFERENCES • Guidelines – BPIGS - Best Practice in Surgery http://bestpracticeinsurgery.ca/guidelines/
• Bailey & Love's Short Practice of Surgery – 27th Edition.