Gastroenterology
Acute & Chronic Pancreatitis
Gastroenterology

Acute & Chronic Pancreatitis

I GET SMASHED + LR > NS + complications.

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◆Etiology (I GET SMASHED)

  • •Idiopathic, Gallstones, ETOH, Trauma, Steroids, Mumps, Autoimmune, Scorpion, Hypercalcemia/hypertriglyceridemia, ERCP, Drugs

◆Diagnosis (2 of 3)

  • •Epigastric pain radiating to back
  • •Lipase/amylase >3× ULN
  • •Characteristic imaging (CT)

◆Management

  • •Aggressive IV LR (preferred over NS) + pain control + bowel rest
  • •Early oral nutrition once tolerated (don't routinely fast)
  • •Antibiotics ONLY for infected necrosis
  • •ERCP only if gallstone with obstruction or cholangitis
  • •Severe hyperTG → insulin infusion or plasmapheresis

◆Complications

  • •Acute peripancreatic fluid collection (<4 weeks)
  • •Pancreatic pseudocyst: fluid collection with fibrous wall ≥4 weeks; asymptomatic + <6 cm → observe; symptomatic/large → endoscopic drainage
  • •Walled-off necrosis: similar but with necrotic debris
  • •Pancreatic abscess: fluid + leukocytosis + fever
  • •Recurrent pancreatitis without alcohol/gallstones → check triglycerides
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