✅ پانکراتیت حاد:
* لینک کیس همراه با توضیحات.

یکی دیگه از اورژانس‌های درد شکم.

▪︎کرایتریای تشخیصی(۲ مورد از ۳ مورد زیر که بطور خلاصه میشه شرح حال تیپیک/آنزیم لیپاز یا آمیلاز بیشتر از ۳ برابر/یافته های تصویربرداری):
The diagnosis of acute pancreatitis requires the presence of two of the following three criteria: acute onset of persistent, severe, epigastric pain often radiating to the back, elevation in serum lipase or amylase to three times or greater than the upper limit of normal, and characteristic findings of acute pancreatitis on imaging (contrast-enhanced computed tomography [CT], magnetic resonance imaging [MRI], or transabdominal ultrasonography).

▫️چه زمانی برای تشخیص تصویربرداری کنیم؟
In patients with abdominal pain that is not characteristic for acute pancreatitis or serum amylase or lipase levels that are less than three times the upper limit of normal, in whom the diagnosis is uncertain, we perform abdominal imaging with a contrast-enhanced abdominal CT scan to establish the diagnosis of acute pancreatitis and to exclude other causes of acute abdominal pain. In patients with severe contrast allergy or renal failure, we perform an abdominal MRI without gadolinium.

▪︎اساس درمان؟
The most important treatment for acute pancreatitis is aggressive fluid therapy! You start serum therapy with an isotonic serum (ringer lactate is choice) 20cc/kg stat and then 2-3 cc/kg/hr IV infusion to maintain urine output more than 0.5cc/kg/hr.(Harrison).

که آپتودیت ریت و حجم کمتری رو میگه:(ویس توضیحات در کپشن هست)
We use moderate intravenous hydration (1.5 mL/kg/hour with a 10 mL/kg bolus in patients with hypovolemia) with goal-directed therapy for fluid management.(Uptodate).

▪︎درباره آنتی‌بیوتیک؟
Adding antibiotics is forbidden in acute pancreatitis unless 2 important complications:
1) acute cholangitis (fever + icter + RUQ pain)
2) INFECTIOUS necrotizing pancreatitis (which is diagnosed by FNA).
Adding antibiotics increase fungal infection risk.

▪︎با چی‌ بیمار رو فالو کنیم؟
The best follow up tests are hematocrit and BUN which shows dehydration level. You can measure them BD or TDS. HCT>44% and/or BUN>22 shows bad prognosis in acute pancreatitis. In this situation, you should repeat your stat serum and rise your maintenance serum up to 1.5 cc/kg/hr.

▪︎درباره آمیلاز و لیپاز هم بدانیم که(لیپاز زودتر بالا میره و مدت بیشتری هم بالا میمونه پس بهتره):
◽We evaluate levels of serum lipase alone. Lipase remains elevated for a longer period of time and has a higher specificity as compared with amylase.

◽Although measurement of serum amylase and lipase is useful for diagnosis of pancreatitis, serial measurements in patients with acute pancreatitis are not useful to predict disease severity, prognosis, or for altering management.

▪︎کلا کی بریم سمت تصویربرداری برای فالو کردن بیمار:
When you didn’t catch response after 3-5 days of treatment and the pain and clinic doesn’t improve, CT scan is indicated to see whether there is necrotizing pancreatitis or not. Unless imaging is not indicated.

▪︎Checking TG and calcium level is wise in unexplained pancreatitis!

➡️
• Clinical manifestations and diagnosis of acute pancreatitis.
• Predicting the severity of acute pancreatitis.
• Management of acute pancreatitis.