pancreatitis revisited

 Today we discussed a patient from last night who presented with sever pancreatitis, with necrosis on  CT scan.

Here is a LINK to our last discussion of pancreatitis. 

Typically, not everyone gets a CT scan,


Indications for CT scanning include: 

• High fevers or signs of sepsis 
• Severe pancreatitis 
• Failure to improve with conservative therapy 

CT scanning is helpful for several reasons: 

• prognosis (See this article for the CT scoring index)_
• presence or absence of local complications,(eg pseudocyst  that would need for surgical intervention)
• Determining the need for antibiotics 

Speaking of antibiotics...

The use of antibiotics for pancreatitis is controversial. In general  antibiotics should be given if there is necrosis seen on CT scan (especially if > 30% of the pancreas). The first-line antibiotic appears to be a beta-lactam (Imipenem is what is typically used)

Here is a Cochrane review of this dilemma.

acute panc

Today we discussed the etiology and prognostic considerations in acute pancreatitis.

A great article that addressees the prognostic scores and some guidelines is here.

This includes a newer predictive score:

BUN>9

Impaired mental status

Sirs (2 criteria)

Age >60

Pleural effusion

A score of 3 or more correlates with high risk of death or sever pancreatitis.

Less than 3 had a 99% NPV for death (WOW).

Those are hopefully the ones we see more often on the ward.

The RANSON"s score, which is more often referred to, does point out some important complications to watch for, such as hypoglycaemia and hypocalcemia.

The NEJM review can be found here.