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Internal Medicine
Severe acute pancreatitis:
• Refer to hospitals for admission to intensive care unit
• Vital signs and urine output are monitored at least every 1 hr
• Accurate metabolic flow sheet which should be checked every 8 hrs.
Arterial blood gases are determined as necessary
Hct, glucose, electrolytes (Ca, Mg), CBC, platelet count, coagulation parameters,
total protein with albumin, BUN, creatinine, amylase, and lipase studies performed
Keep patient NPO with NG tube insertion
Give H2 receptor blockers IV
Fluids may be given up to 6 - 8 L/d.
Give oxygen as needed
Severe pain should be treated with Pethidine 50 to 100 mg IM every 4 to 6 hrs and
as needed in patients with normal renal function (morphine causes the sphincter of
Oddi to contract and should be avoided).
Treat hyperglycaemia if over 250 mg/dl.
If symptoms of calcium depletion appear give calcium gluconate 10 - 20 ml IV in 1
liter of replacement fluid.
Surgery is indicated for
Uncontrolled biliary sepsis
Inability to distinguish acute pancreatitis from other causes of acute abdomen
To drain a pseudocyst that is expanding rapidly, secondarily infected, or associated
with bleeding or impending rupture.
4.2. Chronic pancreatitis
Alcoholism : 70 -80% of chronic pancreatitis is associated with alcoholism
Obstruction of the main pancreatic duct due to stenosis, stones, or cancer