Pancreatitis

First Things First (assess & treat for the following)

• Pancreatitis has a wide array of disease severity & should always be taken very seriously. An initially mild case can progress rapidly to fatal disease. It is easy to underestimate the fluid requirements & need for resuscitation.
  • Does pt have evidence of hypovolemia or shock?
    • SBP < 90 mmHg, MAP < 60 mmHg, urine output < 0.5 cc/kg/hr
  • Does pt have electrolyte abnormalities or glucose abnormalities that require immediate attention?
  • Does pt have evidence of the potential hemorrhagic complications of pancreatitis (flank hematoma, decreasing hemoglobin)?
  • Does pt demonstrate evidence of systemic complications?
• Pt w/ 3 or more initial Ranson’s criteria should be monitored & cared for in the ICU (see below).
• Terminology of acute pancreatitis
  • Acute interstitial pancreatitis
  • Necrotizing pancreatitis
    • Sterile necrosis
    • Infected necrosis
  • Pancreatic fluid collection
    • Sterile
    • Infected
  • Pancreatic pseudocyst
    • Sterile
  • Pancreatic abscess