Topic of Medicines

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2. Presenter Junaid Ahmad
Roll No. 195
Treatment

3. Treatment Acute Pancreatitis
 There is no specific treatment
 The treatment is only general management

4. Treatment Acute Pancreatitis
 Severity of disease scores
 Ranson’s score
 Glasgow score
 APACHE II or III score
 Balthazar score

5. Treatment Acute Pancreatitis
Ranson’s criteria
 On admission
 Age >55 years
 WBC >16000
 Blood Glucose >200 mg/dL
 LDH >350 iu/L
 AST (SGOT) > 250 iu/dL
 After 24 hours
 Hematocrit fall >10%
 BUN rise >8mg/dL
 Serum Ca <8mg/dL
 Arterial PaO2 <60 mmHg
 Base deficit > 4mEq/L
 Fluid sequestration >600 mL

6. Treatment Acute Pancreatitis
 Predicted Mortality rates
 Criteria score 0-2 = 2%
 Criteria score 3-4 = 15%
 Criteria score 5-6 = 40%
 Criteria score 7-8 = 100%

7. Treatment Acute Pancreatitis

8. Treatment Acute Pancreatitis
Goal of treatment
Give some rest to pancreas (includes general
management only)

9. Treatment Acute Pancreatitis
 Medical Treatment
 Bed rest
 Give O2 (for ARDS)
 Nothing Per Oral (NPO)
 Total parentral Nutrition (TPN) in beginning
 Shift to nasojugenal feeding (avoid CCK from
duodenum which stimulate pancreas)
 IV fluids (Electrolyte balance)

10. Treatment Acute Pancreatitis
 Medical Treatment
 Whole blood/Fresh Frozen plasma
 Dopamine (If shock is not responding to fluids)
 Pathedine (for pain relief)
 Insulin if required (to treat hyperglycemia)
 Ca gluconate IV (if tetani occurs)
 NG suction (if vomiting)

11. Treatment Acute Pancreatitis
 Medical Treatment
 Role of prophylactic antibiotics is debatable
because studies have shown
 Use of these drugs
○ No benefits
○ Poor penetration
○ Many pts found with Resistant strains due to
prophylactic use
○ & Opportunistic fungal infections

12. Treatment Acute Pancreatitis
 Medical Treatment
 Antibiotics should NOT be used
○ To treat fever (its not due to septicemia)
○ In mild cases
○ Absence of proof of infection
 In severe cases AND where aspiration fluid
shows infections
○ Limited choice of antibiotics due to poor
penetration

13. Treatment Acute Pancreatitis
 Medical Treatment
 Imipenem is drug of choice
 500mg IV 8 hourly
 Penecillins, Cephlosporins and AG have poor
penetration into the organ
 Endoscopic sphincterotomy (ERCP) is done if
cause is obstruction in sphincter of oddi

14. Treatment Acute Pancreatitis

15. Treatment Acute Pancreatitis
 Surgical Treatment
 Almost no role of surgery
 It is said there are three rules of surgery eat what
ever u want , sleep when ever you want but don’t
mess with pancreas
 High mortality associated with pancreatic
procedures
 Surgery is done to correct cause and
complications

16. Treatment Acute Pancreatitis
 Surgical Treatment
 Surgical debridement may be required for
necrosed tissue in severe cases
 Post operative continuous drainage and irrigation
is required under CT or ultra sound guide (to avoid
trauma to other tissues)
 If pancreatic juice is leaking
 From tail, a distal pancreatectomy
 From head, a Whipple procedure

17. Treatment Acute Pancreatitis

18. Treatment Acute Pancreatitis
 Prevention of Recurrence
 Cholecystectomy on same admission to hospital
if cholecystitis is the cause
 Ask patient to stop alcohol
 Stop Drugs (sulfonamides, tetracycline, valproic acid,
methyldopa, estrogens, furosemide, corticosteroids, and
octreotide)
 Treat the hyperlipidemia
 Ask pt to come after 7-10 days
 Tell pt about the complications

19. Treatment Acute Pancreatitis
 Treat complications
 When pseudocysts are symptomatic (ie,
associated with pain, bleeding, or infection) or
are larger than 7 cm and are rapidly expanding in
an acutely ill patient,
○ Percutaneous aspiration
○ Endoscopic (transpapillary or transmural )
 If abscess is formed percutaneous catheter
drainage and use antibiotics
 In case other systems consult expertise