title: Pancreatitis tags: #FFICM notebook: ð-FFICM type: inprogress
source: [[MCQs and SBAs in Intensive Care Medicine (Oxford Higher Special Training)]]
FTFTF
Both a rise in serum amylase, and clinical assessment, are poor indicators of severity in the first 48 hours. Contrast-enhanced CT will confirm diagnosis and the presence of gallstones, and detect early abscess formation and necrosis of the pancreas. This should be done at initial presentation if the diagnosis is uncertain. However, if looking for local complications, this should be delayed 48â72 hours as necrosis may not be visualized early. Ranson score is performed on admission and 48 hours later. Amylase is not included. There is lack of evidence for routine prophylactic antibiotics; however, if there is evidence of an infected abscess or sepsis elsewhere, antimicrobials should be commenced. If clinically appropriate surgery should be delayed 2â3 weeks to allow for demarcation of the necrotic pancreas. Delayed surgery is associated with increased survival. Nathens Avery B, et al. Management of the critically ill patient with severe acute pancreatitis. Critical Care Medicine 2004;32:2524â36
| Flashcard | type:basic |
|---|---|
| Is amylase any use in severity of pancreatitis in the first 48 hours? | No |
| Is clinical assessment any use in severity of pancreatitis in the first 48 hours? | No |
| What is the test to diagnose pancreatitis, gallstones, and abscess/necrosis? | CT with Contrast |
| When should you perform CT with Contrast to look for complications of pancreatitis? | Delay 48-72hrs |
| When should you perform CT with Contrast to look for pancreatitis if attempting to make diagnosis? | On presentation |
| What is the Ranson score used for? | Pancreatitis Severity |
| Is there evidence for routine prophylactic abx in necrotising pancreatitis? | No |
| How long should you try and hold off before performing surgery in necrotic pancreatitis? | 2-3 weeks |
Revision Notes in ICM
[[Revision Notes In Intensive Care]]
7.1 Pancreatitis
| Flashcard | type:cloze |
|---|---|
| The three things you need for {{c1::Acute Pancreatitis::condition}} are {{c2::Abdominal Pain::symptom}} {{c3::Amylase 3x Higher Than Normal::symptom}} {{c4::Characteristic CT Findings::symptom}} |
|
| The five parts of the Ranson Score for Acute Pancreatitis performed on {{c1::admission::timing}} are {{c2::Age 55+::part}} {{c3::AST 250+::part}} {{c4::Glucose 11.2+::part}} {{c5::White Cells 16+::part}} {{c6::LDH 350+::part}} |
|
| The five parts of the Ranson Score for Acute Pancreatitis performed on {{c1::24hours::timing}} are {{c2::Haematocrit Fall 10%+::part}} {{c3::PaO2 Less Than 8::part}} {{c4::Base Defecit 4+::part}} {{c5::6L Fluid Sequestered::part}} {{c6::Urea Rises 1.8::part}} |
|
| The eight parts of the Glasgow Imrie Score for Acute Pancreatitis performed on admission are {{c1::Oxygenation::part}} {{c2::Age::part}} {{c3::White Cells::part}} {{c4::Calcium::part}} {{c5::Urea::part}} {{c6::LDH::part}} {{c7::Albumin::part}} {{c8::Glucose::part}} |
|
| Urgent ERCP is indicated for acute pancreatitis treatment if there is {{c1::cholangitis::condition}} {{c2::cholestatsis::condition}} {{c3::predicted severe gallstone pancreatitis::condition}} |
Basic Anki
| Flashcard | type:basic |
|---|---|
| What should be the first imaging to use when looking for pancreatitis? | Ultrasound |
| How common is necrosis seen on CT in pancreatitis? | ~ 15% |
| How common is interstitial oedema of pancreatic parenchyma seen on CT in pancreatitis? | ~ 85% |
| What is the classic CT change in acute pancreatitis seen in majority of cases? | Interstitial Oedema in Pancreatic Parenchyma |
| What is the Atlanta Criteria for? | Severity of Acute Pancreatitis |
| What does the Atlanta Criteria for Acute Pancreatitis has as categories? | Mild, Moderate, Severe |
| What counts as mild acute pancreatitis on the Atlanta criteria? | No organ failure or systemic complication |
| What counts as moderate acute pancreatitis on the Atlanta criteria? | Less than 48hrs of organ failure/complication |
| What counts as severe acute pancreatitis on the Atlanta criteria? | More than 48hrs of organ failure/complication |
| What is the single most important determinant of outcome in Acute Pancreatitis? | Presence of Persistent Organ Failure |
| As opposed to the Atlanta Criteria for Acute Pancreatitis, what does the "determinant-based" classification system have as categories? | Mild, Mod, Severe, Critical |
| What is the Ranson Scoring system used for in acute pancreatitis? | Severity Scoring / Prediction of Mortality |
| What type of acute pancreatitis was the Ranson score initially validated on? | Alcohol Induced |
| When do you perform the Ranson Score for Acute Pancreatitis? | Half done on Admission, Half done on 24hrs |
| How high a Ranson score for acute pancreatitis is severe? | 3 |
| What category of acute pancreatitis does a ranson score of 3 mean? | Severe |
| A Ranson Score for acute pancreatitis of less than 2 means a mortality of about | 2% |
| A Ranson Score for acute pancreatitis of 3 or 4 means a mortality of about | 15% |
| A Ranson Score for acute pancreatitis of 5 or 6 means a mortality of about | 40% |
| A Ranson Score for acute pancreatitis of 7 or 8 means a mortality of about | 100% |
| The Maximum you can score on the Ranson Score for Acute Pancreatitis is | 10 |
| When do you perform the Glasgow-Imrie score for Acute Pancreatitis? | On Admission |
| How many parts are in the Ranson Score for Acute Pancreatitis? | 10 |
| How many parts are in the Glasgow-Imrie score for Acute Pancreatitis? | 8 |
| What is the difference between validation for Ranson and Imrie scores for Acute Pancreatitis? | Ranson validated on alcohol, Imrie validated on Gallstones and Alcohol |
| Should you feed acute pancreatitis patients? | Yes |
| Who should get NJ feeding in acute pancreatitis? | If failed NG |
| Who should get parenteral feeding in acute pancreatitis? | If totally failed enteral |
| Should you give probiotics to acute pancreatitis patients? | No |
| Why shouldn't you give probiotics to acute pancreatitis patients? | Causes bowel ischaemia and death? |
| What trial showed harms of probiotics in acute pancreatitis patients (bowel ischaemia and death) | PROPATRIA |
| What did the PROPATRIA trial show in acute pancreatitis? | Probiotics cause increased bowel ischaemia and death |
| Should you perform ERCP for mild pancreatitis? | No, too high risk of manking it worse |
Plus some questions from [[mcqs-and-sbas-in-intensive-care-medicine-oxford-higher-special-training]]
| Flashcard | type:basic |
|---|---|
| In acute pancreatitis, should you use Hartmann's or Normal Saline? Why? | Hartmann's, lesser incidence of SIRS with it |
| What is the other main name for Hartmann's solution? | Ringer's Lactate |
| What is the other main name for Ringer's Lactate? | Hartmann's Solution |
| Should you give prophylactic antibiotics to acute pancreatitis patients? | No |
| Should you give prophylactic antifungals to acute pancreatitis patients? | No |
| If you were to give indomethacin post ERCP for a patient, how would you give it? | PR |
| If you were to give indomethacin post ERCP for a patient, why would you give it? | To reduce incidence of pancreatitis |
| If you were to give a drug post ERCP for a patient, to reduce chance of pancreatitis, what would you give? | Indomethacin |
| What class of drug is indomethacin? | NSAID |