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Old 05-03-2012
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Pancreas Acute and chronic pancreatitis management

What should be the investigation and management in patient with acute and chronic pancreatitis??
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Old 05-03-2012
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acute: (the ques will mostly provide the labs that provide prog)
Pancreatic enzymes (amy,lyp) initial test
CT (best after 48 to assess prog) most accurate
ECRP recurrent with no obvious cause
AXR, US, CXR could be used but they are neither initial nor best (in b/w)

mgm: pain killer (not morphine), iv fluids

infected necrosis (develop after1-2w)/ abscesses (develop after 4-6w) antibiotics + drain.
Pseudocysts (develop after 2-4w) follow if asymptomatic, drain if symptomatic, growing (6/5cm), persist >5/6wk

AXR is initial i think showing calcification (low sen, very high spe)
if neg and suspecting CT of-course
if positive i think we proceed to mgm

but the best test CT, ERCP (i think the last)

mgm: nutrition, mgm of DM if present and pancreatic enzymes

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Old 05-05-2012
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Acute Edematous Pancreatitis :-
Investigation : initially S. lipase and amylase
* Most accurate test is CT abdomen .
Management : NPO , NG suction , I.V fluid and observe for complications .

Acute Hemorrhagic Pancreatitis :-
Investigation : same as acute edematous pancreatitis .
Management : very intensive support bcz it's fatal and daily serial CT abdomen required to diagnose pancreatic abscess .

Chronic Pancreatitis :-
Investigation : best initial step is CT abdomen
*best accurate test is ERCP
*further investigations = plain X-ray (calcification) , R.B.S .
Management: stop alcohol intake (if pt is alcoholic) , replace pancreatic enzymes , control DM (with high R.B.S)
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