This document summarizes the diagnosis, etiology, management, and treatment of acute pancreatitis based on guidelines from the American College of Gastroenterology. It presents a case study of a 47-year-old female diagnosed with gallstone pancreatitis based on abdominal pain, elevated lipase, and ultrasound findings of cholelithiasis. Her case is used to illustrate the guidelines, including IV fluid hydration, no antibiotics given due to mild symptoms resolving in 48 hours, and cholecystectomy before discharge due to gallstone etiology.
Please note, the MCQs(Multiple choice questions) on this ppt are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations.
https://www.youtube.com/watch?v=7k5kba0TNRM
https://www.youtube.com/watch?v=kcGi5_xm0Uk
https://youtu.be/lSdnQVdLySg
Please note, the MCQs(Multiple choice questions) on this ppt are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations.
https://www.youtube.com/watch?v=7k5kba0TNRM
https://www.youtube.com/watch?v=kcGi5_xm0Uk
https://youtu.be/lSdnQVdLySg
An up to date on the management of the acute abdomen. Including case presentations of x-rays, CT scans & laparoscopy images and the highlights of their management. Mainly intended for surgical trainees preparing for their exams.
Please note, the MCQs(Multiple choice questions) on this ppt are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations.
This PPT presentation is Image Based Questions of Hepato-Biliary-Pancreatic pathologies. This is useful as self-assessment and review of the subject. This is also useful for USMLE and NEET exams
A detailed description of diagnosing and managing peritonitis and catheter-related infections in peritoneal dialysis patients.
A practical guide for Nephrologists and health care professionals.
Gi hemorrhage/ problem oriented case based teaching- my online classSelvaraj Balasubramani
GI Hemorrhage- Problem Based Learning- Case Scenario Triggers
You can watch the answers in the following video in YouTube
https://www.youtube.com/watch?v=i_UrQ2oSVEQ&t=31s
Please note, the MCQs(Multiple choice questions) on this ppt are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations.
https://www.youtube.com/watch?v=1o3JdzgBM9g
https://www.youtube.com/watch?v=7k5kba0TNRM
https://www.youtube.com/watch?v=kcGi5_xm0Uk
An up to date on the management of the acute abdomen. Including case presentations of x-rays, CT scans & laparoscopy images and the highlights of their management. Mainly intended for surgical trainees preparing for their exams.
Please note, the MCQs(Multiple choice questions) on this ppt are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations.
This PPT presentation is Image Based Questions of Hepato-Biliary-Pancreatic pathologies. This is useful as self-assessment and review of the subject. This is also useful for USMLE and NEET exams
A detailed description of diagnosing and managing peritonitis and catheter-related infections in peritoneal dialysis patients.
A practical guide for Nephrologists and health care professionals.
Gi hemorrhage/ problem oriented case based teaching- my online classSelvaraj Balasubramani
GI Hemorrhage- Problem Based Learning- Case Scenario Triggers
You can watch the answers in the following video in YouTube
https://www.youtube.com/watch?v=i_UrQ2oSVEQ&t=31s
Please note, the MCQs(Multiple choice questions) on this ppt are according to the specifications and syllabus of Specialty Certificate Examination (SCE) in Gastroenterology and the European Section and Board of Gastroenterology and Hepatology Examination (ESBGHE). However, they provide useful knowledge in the relevant subject area in general. Hence, it is recommended you to go through these videos and gather some information to gain success in future medical and surgical field examinations.
https://www.youtube.com/watch?v=1o3JdzgBM9g
https://www.youtube.com/watch?v=7k5kba0TNRM
https://www.youtube.com/watch?v=kcGi5_xm0Uk
Robert Balfanz, Johns Hopkins University
Edmund Baker, Jr., South Columbus High School
Wiliam Ragland II, Johns Hopkins University
Jennifer Felker, Ohio Department of Education
How Cloud B2B Enables Michelin’s International OperationsMark Morley, MBA
This webinar was prepared with the help of Michelin and discusses how Cloud B2B integration helps to support Michelin’s international operations. The presentation discusses some of the trends across today's manufacturing industry before Michelin discusses how they manage international operations using B2B solutions from OpenText. Updated May 2014
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Acute pancreatitis atlanta classification & managementSeneeth Peramuna
Acute Pancreatitis
Definition,
Etialogy and pathogenesis
Atlanta Revised classification
Initial risk assesment
Management of general condition, local and systemic complications
BISAP score
Modified Marshall score
Abnormal abdominal CT is best powerpoint presentation for radiologist, radiology resident and gastroenterologist, this include pancreatitis, all abdominal trauma grading with systemic manner. Thanks
Management of Acute Pancreatitis By Dr. Dhaval Mangukiya
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
Pancreatitis is a dreaded condition associated with development of acute and sudden inflammation of the pancreas.
Pancreatic enzymes are released in the abdomen and cause inflammation by the damage from digestion of normal body structures, especially fat in the abdomen.
Mortality ranges from 3 percent in patients with interstitial edematous pancreatitis to 17 percent in patients who develop pancreatic necrosis.
Nuclear medicine in biliary tract disordersRamin Sadeghi
In this presentation, application of nuclear medicine in biliary tract disorders is explained including cholecystitis, sphicter of Oddi dysfunction, neonatal cholestasis, biliary leak, etc.
Drs. Rossi and Shreve’s CMC Abdominal Imaging Mastery Project: May CasesSean M. Fox
Dr. Brian Shreve is an Emergency Medicine Resident and Dr. Isolina Rossi is a Surgery Resident at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides on:
• Splenic Laceration
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Urinary tract consists of kidneys, ureters, urinary bladder and the urethra.
Infection most commonly involves the lower urinary tract which includes the bladder (cystitis) and urethra (urethritis).
UTI (Urinary Tract Infection) typically is caused by bacteria entering the bladder through the urethra. E.coli (Escherichia coli) is the most common bacteria responsible for UTI
To get relevant relevant details, Check out doctors article --> https://www.icliniq.com/articles/kidney-and-urologic-diseases/urinary-tract-infection-a-brief-overview
Explore the multifaceted world of Muntadher Saleh, an Iraqi polymath renowned for his expertise in visual art, writing, design, and pharmacy. This SlideShare delves into his innovative contributions across various disciplines, showcasing his unique ability to blend traditional themes with modern aesthetics. Learn about his impactful artworks, thought-provoking literary pieces, and his vision as a Neo-Pop artist dedicated to raising awareness about Iraq's cultural heritage. Discover why Muntadher Saleh is celebrated as "The Last Polymath" and how his multidisciplinary talents continue to inspire and influence.
2137ad Merindol Colony Interiors where refugee try to build a seemengly norm...luforfor
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thGAP - Transgenic Human Germline Alternatives Project, presents an evening of input lectures, discussions and a performative workshop on artistic interventions for future scenarios of human genetic and inheritable modifications.
To begin our lecturers, Marc Dusseiller aka "dusjagr" and Rodrigo Martin Iglesias, will give an overview of their transdisciplinary practices, including the history of hackteria, a global network for sharing knowledge to involve artists in hands-on and Do-It-With-Others (DIWO) working with the lifesciences, and reflections on future scenarios from the 8-bit computer games of the 80ies to current real-world endeavous of genetically modifiying the human species.
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2. o Establish the Diagnosis of Acute Pancreatitis
o Establish the Etiology of Acute Pancreatitis
o Initial Management of Acute Pancreatitis
All recommendations are based on the latest ACG Management of
Acute Pancreatitis guidelines published in 2013.
Objectives
3. o Diagnosis of Acute Pancreatitis requires at least 2 of 3 from the following
criteria:
o Abdominal pain consistent with acute pancreatitis
o Serum amylase or lipase greater than 3 times the upper limit of normal
o Characteristic findings on abdominal imaging
o CT w/ contrast or MRI should be reserved for patients in whom the diagnosis in
unclear or fail to improve within 48-72 hours.
A. Diagnosis
4. 47 year-old female with recent mild alcohol intake and no history of prior
gallstones or acute pancreatitis presents to ER with epigastric abdominal pain
radiating to the back. Lipase is 500 on admission.
o Diagnosis: Met the following 2 of 3 criteria (1) abdominal pain consistent
with acute pancreatitis (2) Lipase > 3 times upper limit of normal – therefore,
no CT or MR imaging required to establish diagnosis.
Case Vignette
5. o Transabdominal ultrasound should be performed in ALL patient with acute
pancreatitis to assess gallstones as etiology of acute pancreatitis.
o In absence of gallstones or significant alcohol use, obtain serum triglycerides.
o If serum triglycerides > 1,000 mg/dL, consider as etiology of acute
pancreatitis.
o In patients > 40 years of age, consider pancreatic tumor in absence of other
causes.
o In patients < 30 years of age and +FH of acute pancreatitis in absence of other
causes, consider genetic testing for hereditary pancreatitis.
B. Etiology
6. o Etiology: As all patients with acute pancreatitis are recommended to get
transabdominal ultrasound, a RUQ ultrasound was done which showed
cholelithiasis and CBD dilatation without choledocholithiasis. Likely etiology
was gallstone pancreatitis with or without a component of alcohol-induced
acute pancreatitis.
Case Vignette – cont.
7. o Various methods exist to assess severity of acute pancreatitis.
o Next slide describes clinical findings associated with a severe course of acute
pancreatitis.
o BISAP score is a helpful tool in assessing severity and in-hospital mortality of
acute pancreatitis.
o BISAP, Ranson’s, APACHE-II and CTSI scores all have similar prognostic
accuracy.
C. Severity Assessment
8. Severity Scoring of Acute Pancreatitis
Bedside index of severity in acute pancreatitis (BISAP) score
Presence of organ failure and/or pancreatic necrosis defines Severe Acute
Pancreatitis.
Patients with high severity of initial presentation and/or presence of end-organ failure
(shock, AKI, altered mental status, respiratory failure, ARDS, etc) should be admitted to ICU.
9. o Early AND Aggressive IV fluid hydration must be initiated.
o How aggressive?
o If severe hypovolemia present, bolus IV fluids initially
o Then keep maintenance rate of 250 – 500 mL/hr IV fluids
o What kind of IV fluids?
o Isotonic crystalloid (NS, LR)
o LR may be preferred (conditional recommendation)
o How soon to start?
o Early, early, early !!
o Most beneficial in the first 12-24 h
o What is my goal with IV fluid hydration?
o Decrease BUN (as checked q6h initially)
D. Initial Management
10. o Management: NPO, IV fluid hydration at 250-500 cc/hr with monitoring BUN
q6h with goal of IVF hydration to decrease BUN in the first 12-24 hours.
Case Vignette – cont.
11. o Do NOT #1: Routine use of prophylactic antibiotics for severe acute
pancreatitis is NOT recommended.
o Do NOT #2: Use of antibiotics to prevent progression of sterile necrosis to
infected necrosis is NOT recommended.
o Keep in mind that patients with acute pancreatitis often and early have
fever but this does not necessarily mean infected necrosis exists.
E. Role of Antibiotics
12. o Think of infected necrosis if patient with pancreatic or extra-pancreatic
necrosis fails to improve after 7-10 days of hospitalization.
o In case of infected necrosis, either FNA with gram-stain and culture to
narrow antibiotic regimen or empirically treat with antibacterial
antibiotics.
o Routine antifungal therapy is not recommended unless specifically
indicated based on culture and/or gram-stain.
E. Role of Antibiotics
13. o Antibiotics role: Despite spiking one fever to 101 F, no clinical concern for
infected necrosis existed and patient improved clinically within 48 hours. No
antibiotics were therefore initiated.
Case Vignette – cont.
14. o NG versus NJ tube feeding are COMPARABLE in efficacy and safety.
o In other words, do NOT delay enteral feeding because NJ tube is not
present.
o IV nutrition should be avoided unless enteral nutrition is not available, not
tolerated, or not meeting caloric requirements.
o Enteral feeding is not merely to meet caloric requirements; it also prevents
infectious complications.
o Timing of enteral feeding? Not mentioned in guidelines, but generally if
anticipate patient cannot have PO intake within 48 hours, start enteral
feeding with NG or NJ.
F. Feeding
15. o Enteral feeding: As patient was able to have PO intake within 48 hours,
neither NG nor NJ tube feeding was initiated.
Case Vignette – cont.
16. o Mild acute pancreatitis with gallstones Perform cholecystectomy before
discharge
o Necrotizing acute pancreatitis with gallstones Delay cholecystectomy until
inflammation subsides
o Asymptomatic pseudocysts or sterile necrosis do NOT warrant intervention
(i.e drainage) regardless of size or location.
o Drainage of infected necrosis should be delayed for at least 4 weeks to allow
formation of walled-off necrosis.
G. Role of Surgery
17. o Role of Surgery: Given evidence of gallstones and mild acute pancreatitis,
cholecystectomy was performed before discharge to prevent recurrent
episodes of gallstones pancreatitis.
Case Vignette – cont.
18. o Early and accurate diagnosis of acute pancreatitis is crucial.
o Early treatment of acute pancreatitis with aggressive IV fluid hydration saves
lives and is most beneficial in the first 12-24 hours.
o Routine prophylactic antibiotic use is not recommended for acute pancreatitis
unless presence of infected necrosis is established clinically or by FNA.
o Mild acute pancreatitis due to gallstones warrants cholecystectomy before
discharge.
Summary
19. o Scott Tenner MD, MPH, FACG, John Baillie MB, ChB, FRCP, FACG, John DeWitt MD, FACG and Santhi
Swaroop Vege MD, FACG. American College of Gastroenterology Guideline: Management of Acute Pancreatitis. Am
J Gastroenterol 2013; 108:1400–1415; doi:10.1038/ajg.2013.218; published online 30 July 2013.
References
Editor's Notes
Genetic testing for hereditary pancreatitis is to test for at least three different inheritance patterns for chronic pancreatitis:
1) Autosomal dominant hereditary pancreatitis — This is most often associated with mutations in the serine protease 1 gene (PRSS1) on chromosome 7q35, which encodes trypsin-1 (cationic trypsinogen). Rarely, autosomal-dominant-appearing hereditary pancreatitis is identified in a kindred that does not have an identifiable PRSS1 mutation.
2) Autosomal recessive pancreatitis — Chronic pancreatitis associated with cystic fibrosis is the most common example. Mutations in the serine protease inhibitor Kazal type 1 gene (SPINK1, also called pancreatic secretory trypsin inhibitor gene) also may present in an autosomal recessive pattern. CFTR-associated disorders include chronic pancreatitis with minimal lung disease, and this trait may occur in multiple family members.
3) Complex genetics — Multiple family members may have recurrent acute or chronic pancreatitis associated with a combination of genetic and environmental factors. This is the case for patients with heterozygous SPINK1 mutations, in which the SPINK1 mutation probably acts as a disease modifier, lowering the threshold for developing pancreatitis from other genetic (eg, CFTR mutations) or environmental factors. Some apparently sporadic cases of pancreatitis have complex genetic risk.
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“BISAP, Ranson’s, APACHE-II and CTSI scores all have similar prognostic accuracy.” based on below article:
Am J Gastroenterol. 2010 Feb;105(2):435-41; quiz 442. doi: 10.1038/ajg.2009.622. Epub 2009 Oct 27.
Comparison of BISAP, Ranson&apos;s, APACHE-II, and CTSI scores in predicting organ failure, complications, and mortality in acute pancreatitis.
Papachristou GI, Muddana V, Yadav D, O&apos;Connell M, Sanders MK, Slivka A, Whitcomb DC.
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