Pancreas

#Pancreatitis

Revised Atlanta Classification 2012, 2 of 3: epigastric pain radiating to the back, lipase 3x ULN, CT findings

Etiology possibilities: EtOH, gallstone, hypercalcemia, HyperTG, ERCP, steroid induced, medication induced, trauma

-Per WATERFALL trial, 10ml/kg bolus if hypovolemic, then 1.5ml/kg/hr mIVF (NNH of aggressive fluid resuscitation is ~7 when compared to moderate as above)

-treatment of nausea/vomiting/pain with:

-zofran 4mg IV q6 PRN

-dilaudid 2mg IV q4 PRN

-Recheck labs (CBC, CMP) every 12 hours

-Transabdominal ultrasound to evaluate for fluid collections, evaluate the CBD (understanding mild dilation is to be expected with a post CCY patient)

-If concerning findings on US then consider abdominal CT or MRI pancreas

-resume oral feedings when pain improves and any nausea or vomiting subsides

-if oral feeding not tolerated, enteral feeding should be considered within 72 hours

#autoimmune pancreatitis

High dose prednisone 2-3 months

IgG4

#Walled off pancreatic necrosis

Per POINTER trial (NEJM 2021), early catheter drainage is not superior to delayed drainage

#Pancreatic serous cystadenoma

Mucin-producing cysts, including intraductal papillary mucinous neoplasms and mucinous cystic neoplasms, are thought to have malignant potential.

Non–mucin-producing cysts, such as a serous cystadenoma, have no malignant potential

#h pylori

For patients with dyspepsia, a “test and treat” strategy forHelicobacter pyloriinfection is recommended.

In a person from an area with a low prevalence ofHelicobacter pylori,a positive serologic result is likely a false positive and should be followed by a stool antigen test or a13C urea breath test.

#pancreatic pseudo cyst

Pancreatic pseudocysts are peripancreatic fluid collections that occur with acute pancreatitis and do not contain solid material or debris.

Pancreatic pseudocysts do not require drainage unless the patient is symptomatic or the pseudocysts become infected