# Acute Pancreatitis
-- ABCs: hypotension/shock, resp distress c/f effusions or ARDS
-- HPI Intake: onset, EtOH use, gallstone symptoms, procedures, infectious sxs, family history
-- Can't Miss: sepsis, ARDS, hemorrage
-- Admission Orders: CXR, strict I/O, decide on bowel rest
-- Initial Treatment to Consider: aggressive fluid resuscitation, replete lytes, pain management
-- History: *** onset, prior events, EtOH use, gallstone dx, procedures, infectious sxs, FH
-- Clinical: *** abd pain, n/v, fevers, constipation
-- Exam: *** distress, tachycardia, jaundice, abdominal pain, guarding, flank/umbilical (Grey Turner / Cullen Sign) eccymoses
-- Data: *** WBC, lipase, CTAP
-- Etiology/DDx: *** EtOH, gallstone, hypertriglyceridemia, anatomic, ERCP, autoimmune, hyperCa
The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.
-- CBC, BMP (calcium), LFTs (gallstones, cholangitis), coags, lipase, lipid panel (triglyceride) if new diagnosis
-- CXR if dyspneic or c/f ARDS/effusions
-- CTAP with contrast if severe, not sure of diagnosis, or not improving after 48-72hrs
-- RUQUS to rule out gallstones if not EtOH
-- ERCP if gallstone disease; ideally cholecystectomy prior to discharge
-- Fluids: *** 10mL/kg bolus followed by 1.5cc/kg/hr in first 24 hours
-- Pain: *** dilaudid 1mg q4 PRN
-- Diet: *** early PO, advance as tolerated; tube feeds if no PO intake at 5-7 days
-- Nausea: *** ondansetron 4mg q8 PRN
-- Insulin for hypertriglyceridemia
PDF coming soon!
Make the diagnosis with 2 of 3 of clinical presentation, lipase >3x ULN, and imaging. Give fluids (but not too much), pain meds, and shoot for early PO intake as tolerated. If new and not related to EtOH, get a RUQUS and triglyceride level to search for an etiology.