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Old 02-13-2013
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Pancreas Acute pancreatitis analgesia and antibiotics

Why analgesics as meperidine and fentanyl are preferred over morphine in acute pancreatitis ?

Why we do not give antibiotics in patient of acute pancreatitis with elevated leukocytes ?
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other opiods cause smooth muscle contraction at sphincter of Oddi--->painful crisis, aka biliary colic. I know meperidine is an exception & maybe fentanyl as u said
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Quote:
Originally Posted by aknz View Post
Why we do not give antibiotics in patient of acute pancreatitis with elevated leukocytes ?
This is the management of acute Pancreatitis (in a nutshell):

Acute Pancreatitis- Supportive with NPO I/V fluids
Monitor for s/s of necrosis/infection with serial bloodworks and serial CT scans.

Pancreatic necrosis- Add antibiotics (Imipenam) if more than 30% necrosis on CT scan or if clinical s/s of infection/SIRS even if less than 30% necrosis.

Infected pancreatic necrosis-When clinical signs of infection or SIRS are present in the setting of necrotizing pancreatitis, CT-guided needle aspiration is indicated. Treat with antibiotics based on results of the aspirate/clinically.
Quote:
Surgery is recommended when large areas of the pancreas are necrotic and percutaneous CT-guided aspiration demonstrates infection on the basis of a positive Gram stain result. Antibiotic therapy alone is not sufficient to achieve a cure. Aggressive surgical debridement and drainage are necessary to remove dead tissue and to clear the infection.
Pancreatic abscess-Pancreatic abscesses generally occur late in the course of pancreatitis. Many of these respond to percutaneous catheter drainage and antibiotics. Those that do not respond require surgical debridement and drainage.

Pseudocysts- Drain if more than 5 cm on US or rapid enlargement/infection.
Quote:
Most pseudocysts can be followed clinically. However, when they are symptomatic (ie, associated with pain, bleeding, or infection) or are larger than 7 cm and rapidly expanding in an acutely ill patient, intervention is indicated.

Antibiotic Therapy in Acute Pancreatitis

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Antibiotics, usually drugs of the imipenem class, should be used in any case of pancreatitis complicated by infected pancreatic necrosis. However, they should not be given routinely for fever, especially early in the disease course, because this symptom is almost universally secondary to the inflammatory response and typically does not reflect an infectious process.
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The bottom line is that antibiotic prophylaxis in severe pancreatitis is controversial. At this time, the routine use of antibiotics as prophylaxis against infection in severe acute pancreatitis is not recommended.
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Last edited by Novobiocin; 02-13-2013 at 05:19 PM.
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Quote:
Originally Posted by Novobiocin View Post
[U][B]

[/COLOR]Infected pancreatic necrosis-When clinical signs of infection or SIRS are present in the setting of necrotizing pancreatitis, CT-guided needle aspiration is indicated. Treat with antibiotics based on results of the aspirate/clinically.
According to MTB severe necrosis is indication of needle biopsy. To check for any kind of infection.
and Infected pancreatic necrosis should be resected with surgical debridement to prevent ARDS or death.
So,
CT-guided needle aspiration - Diagnostic test???

antibiotics based on results of the aspirate/clinically- before surgical intervention?? or if we can control infection with antibiotics. We still do surgical debridement right??
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Old 02-14-2013
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Quote:
Originally Posted by koolkiller88 View Post
According to MTB severe necrosis is indication of needle biopsy. To check for any kind of infection.
and Infected pancreatic necrosis should be resected with surgical debridement to prevent ARDS or death.
So,
CT-guided needle aspiration - Diagnostic test???

antibiotics based on results of the aspirate/clinically- before surgical intervention?? or if we can control infection with antibiotics. We still do surgical debridement right??
Right. You do surgical debridement in addition to antibiotics once infection is confirmed.

More than 30% necrosis or s/s of infection even with less than 30% necrosis>>>>>CT guided needle aspiration >>>>>Infection confirmed>>>>Antibiotics & Surgical debridement.
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