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Acute Pancreatitis


Acute Pancreatitis


حالة سريرية

الوصف الكامل Background
A 42-year-old woman is hospitalized because of pancreatitis. On physical examination, the patient appears ill and dehydrated. Temperature is 37.6 °C (99.6 °F), pulse rate is 110/min, respiration rate is 19/min, and blood pressure is 120/90 mm Hg. Abdominal examination discloses diffuse tenderness without rebound.

Laboratory Studies
Hematocrit

54%
Plasma glucose

290 mg/dL (16.1 mmol/L)
Serum triglycerides

1482 mg/dL (16.73 mmol/L)
Serum total bilirubin

0.9 mg/dL (15.39 mmol/L)
Serum aspartate aminotransferase

220 U/L
Serum alkaline phosphatase

110 U/L
Serum lactate dehydrogenase

540 U/L
Serum amylase

62 U/L
Serum lipase

250 U/L
Serum C-reactive protein

Moderately elevated

The patient is given narcotics as needed for pain control. A CT scan of the abdomen performed 3 hours after admission shows marked pancreatic edema and diffuse peripancreatic stranding.

كتابة حرة وطرح موضوع النقاش!
In addition to continuing pain relief as needed, which of the following is the most appropriate next step in managing this patient?

A Intravenous hyperalimentation
B Vigorous intravenous hydration
C Endoscopic ultrasonography
D Endoscopic retrograde cholangiopancreatography

dr.tabban's picture
by


شو الفرق بين أ وب؟

KMG's picture
KMG
طبيب مقيم


b.....hematocreat is 54%....she is dehydrated

Fouad's picture
Fouad
بعد التخرج


Vigorous intravenous hydration
معالجة التهاب البنكرياس المزمن معالجة داعمة

a.m.a's picture
a.m.a
طبيب مقيم


انا لح روح مع ب، لأنو الزلمة فاقد سوائل منيح ببطنه.

KMG's picture
KMG
طبيب مقيم


B

moonberg's picture
moonberg
بعد التخرج

Quote:
انا لح روح مع ب، لأنو الزلمة فاقد سوائل منيح ببطنه

يحرق حريشك...ساويتها زلمة.....

Fouad's picture
Fouad
بعد التخرج


exactly,the most important thing in treating acute pancreatitis is proper hydration.

here's the explanation:
This patient has hyperlipidemic pancreatitis with several laboratory findings indicative of a poor prognosis (elevated glucose, aspartate aminotransferase, and lactate dehydrogenase levels). She is markedly volume depleted (as indicated by the elevated hematocrit value), which is also a poor prognostic sign. Vigorous hydration is critical in order to maximize pancreatic perfusion and thus possibly reduce the number of subsequent complications.

Intravenous hyperalimentation is inappropriate because a patient with severe pancreatitis requires enteral, rather than parenteral, nutritional supplementation. Endoscopic ultrasonography is usually done to exclude common bile ducts stones in a patient with acute pancreatitis. However, stones are unlikely to be present in someone with hyperlipidemic pancreatitis. Likewise, endoscopic retrograde cholangiopancreatography is appropriate for diagnosing suspected common bile duct stones and cholangitis in a patient with severe biliary pancreatitis but not with hyperlipidemic pancreatitis.

dr.tabban's picture
dr.tabban


زلماية، ما بيفرق.. هذا منشان المساواة بين الجنسين!

KMG's picture
KMG
طبيب مقيم

Quote:
Serum triglycerides

1482 mg/dL (16.73 mmol/L)

وغالبا سبب الحالة هو ارتفاع الشحوم الثلاثية الشديد مشان هيك شاكك بالجواب الأول كمان

moonberg's picture
moonberg
بعد التخرج


يالله مع الشباب ب

qusei

Quote:
معالجة التهاب البنكرياس المزمن معالجة داعمة

عفوا الحاد

a.m.a's picture
a.m.a
طبيب مقيم

Quote:
Intravenous hyperalimentation is inappropriate because a patient with severe pancreatitis requires enteral, rather than parenteral, nutritional supplementation

Aha good hint thanx Dr Mohanad

moonberg's picture
moonberg
بعد التخرج


بس مو مريض ال acute pancreatitis لازم نحطو NPO وتغذية وريدية

moonberg's picture
moonberg
بعد التخرج


i am with the second answer i think

whatever's picture
whatever
بعد التخرج


acute pancreatitis = IV fuids "loads of fluids" + antiemtics + NPO

dr.tabban's picture
dr.tabban


شو مشان انه الحالة بتخصني ليش التعدي على البنكرياس !! هو خلقة ربه ماله غير كم حالة كمان بتاخدولي ياهم Crying or Very sad Crying or Very sad

drhanadi's picture
drhanadi
طبيب مقيم

Quote:
شو مشان انه الحالة بتخصني ليش التعدي على البنكرياس !! هو خلقة ربه ماله غير كم حالة كمان بتاخدولي ياهم Crying or Very sad Crying or Very sad

يالله بسيطة Eye-wink

qusei


ليش في سرطانات البنكرياس والمجل كتير حلو مناقشتها

moonberg's picture
moonberg
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