Pancreatitis

Introduction
Inflammation of the pancreas due to activation, interstitial liberation and digestion
of the gland by its own enzymes.
Ranson's Severity Criteria
At Presentation
Age>55years
WBC>16X109/L
Glucose>10mM (Non diabetic)
LDH>350 IU
AST>250u/L

During the first 48 hours

Hematocrite fall>10%
Yrea rise >10mM
Serum Calcium <2.0 mmol/L
Base excess > 4 mmol/L
PaO2,8kPa
Serum Albumin, 32g/l
Estimated fluid sequestration > 6lts
Score: <3 Mortality 3% = Mild Pancreatitis; 3 = 15%; 6 = 40%; >7 = 100%
Investigations

Amylase: significant if rise is 4 times upper limit or normal

Complete blood count: Raised Hematocrite and Leukocrytosis
Electrolyes and creatinine: Creatinine may rise due to hypovolaemia
Blood Glucose: May be raised
Liver function test: AST and bilirubin is often elevated especially in
gallstone pancreatitis
Calcium: Hypocalcaemia
Chest X ray: May show elevated diaphragm, pleural effusion
Abdominal X ray: May show dilated gas filled loop in region of pancreas
Management
a.
b.
c.
d.
e.
f.

Check ABC, Check oxygen saturation, Check bed side blood usgar
IV open with normal saline (Sometimes may need resuscitation)
Send blood for investigations
Pain Management: Pethidine/Procholrperazine
Keep NPO
Antibiotics: Ceftriaxone 1gm IV to prevent secondary infection

g. Adequate hydration
h. Liasion with surgery team
Pancreatit
is
Ranson's Score
<3

Ranson's Score
>3

Conservative
Therapy

Aggressive IV hydration
(250 ml hourly for first 48
hours if cardiac status
permits) and antibiotic,
enteral or total parental

May need critical

care

No

Improveme
nt
Yes

Continue antibiotics for 7-10 days, enteral or total

parental nutrition

Admission Criteria
Acute pancreatitis with significant pain, nausea and vomiting
Hemorrhagic or necrotizing pancreatitis
Discharge Criteria
Mild acute pancreatitis without evidence of Biliary tract disease and able to
tolerate oral fluids
Chronic pancreatitis with minimal abdominal pain and able to tolerate oral
fluids