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Transcript
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
daily.
•
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
•
Trauma
•
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
Etiology:
•
Alcoholism : 70 -80% of chronic pancreatitis is associated with alcoholism
•
Idiopathic
•
Hereditary
•
Microlithiasis
•
Hyperparathyroidism
•
Obstruction of the main pancreatic duct due to stenosis, stones, or cancer
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