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Old 01-21-2011
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Pancreas Pancreatitis with necrosis

Hi everyone, I want to ask about the steps in management/diagnosis of pancreatitis

what is the best initial test? I think amylase and lipase

Most accurate test? I think CT

now my questions:
1 what is the best next step after they give a description of pancreatits?
2 If we see >30% necrosis on CT what is the best next step? Antibiotics OR needle aspiration to determine what infection there is?
3 if we see <30% necrosis on CT what is the next best step?

Thank you
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Old 01-21-2011
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Arrow This is what I think

Best next step if they describe a pancreatitis case depends on whether they did lipase or not. If they did not do it, then it's the next best step. If the diagnosis is already confirmed then you need to start supportive therapy which is NPO, suction, and IV fluids.

The issue of 30% CT scan necrosis is a threshold for severity and corresponds to Ranson criteria of 8 and more.

In severe pancreatitis, the management does not differ, it's still conservative as drainage, antibiotics, surgical intervention have all proven unsuccessful.
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Old 01-22-2011
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Hi, thanks for your reply, regarding best next step in pancreatitis lets assume that they give you lipase and amylase are elevated, whats the best next step? is it CT? or straight to management (NPO etc)

Also, if there is more than 30 percent necrosis, kaplan says prophylactic Imepenem for sure, but my question is should needle aspiration be done BEFORE giving the Imepenem?? if not, when should needle aspiration be done?
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