Surgery Oral Exam: Pancreatitis

Terms in this set (18)

Old man with drinking problem with abdominal pain.
HPI?
Onset, duration, frequency
Has this ever happened before
Better / worse
Location, quality
Radiation
Anorexia
Jaundice?
Nausea/vomiting
Fever
Recent illness, trauma
Old man with drinking problem with abdominal pain.
DDx?
Cholecystitis
Lower lobe pneumonia
Bowel perforation
MI
Pancreatic cancer
Gastroenteritis
Old man with drinking problem with abdominal pain.
Past Medical History?
All medical problems including history of gallbladder disease/stones, cystic fibrosis, diabetes, cancer, viral infections, hypertriglyceridemia, trauma, alcohol abuse, jaundice
Old man with drinking problem with abdominal pain.
Past Surgical History?
All surgeries including history of ERCP, does he still have his gallbladder?
Old man with drinking problem with abdominal pain.
Family History?
All family history including history of cancer, gallbladder disease, pancreas disease, alcoholism
Old man with drinking problem with abdominal pain.
Social History?
Fatty diet, smoking, alcohol (quantify), exercise , recent travel
Old man with drinking problem with abdominal pain.
Medications?
All meds, specifically steroids, sulfa, thiazide/furosemide, statins, valproate, antiretrovirals, flagyl, erythromycin, 6-MP
Old man with drinking problem with abdominal pain.
Allergies and Immunizations?
Ask if he is allergic to anything and if he is up to date with his immunizations.
Old man with drinking problem with abdominal pain.
Physical Exam?
ASK FOR VITALS
Full physical exam, focusing on:
Abdominal and rectal exam with hemoccult
Look for Grey Turner's and Cullen's sign
Signs of dehydration
Old man with drinking problem with abdominal pain.
Labs?
CBC, CMP
Amylase, Lipase (more specific)
Urinalysis
LDH
GGT
ALP
What items are included in Ranson's criteria?
Admission: Age (>55), glucose (>200), AST (>250), LDH (>350), WBC (>16,000)

After 48hrs: Base deficit (>4) , BUN (inc >5), Fluid req (>6), Ca2+ (<8), HCT (<10%), PaO2 (<60)
Old man with drinking problem with abdominal pain.
Imaging?
Ultrasound can visualize gallstones
If diagnosis is uncertain: CT
Old man with drinking problem with abdominal pain.
Treatment?
Admit, NPO, IVF, NG tube, Pulse ox, PPI, demerol for pain, IV abx
What are some complications of pancreatitis?
Hemorrhagic- (dec H/H), hypotensive, usually due to splenic artery bleeding, take to OR

Necrotizing- take to OR for debridement
What is the treatment for pseudocysts?
Leave alone if they are <6cm or <6 wks old
If they don't resolve, they must be drained percutaneously, EUS guided, cystgastrostomy, cystjejunostomy, cystduodenostomy
What are causes of chronic pancreatitis?
Alcohol, idiopathic, autoimmune
How does chronic pancreatitis present?
Abdominal pain, eventually steatorrhea and DM at 90% function loss. ERCP will show chain of lakes.
How do you treat chronic pancreatitis?
Ductal decompression: Puestow procedure (longitudinal pancreaticojejunostomy) for pain relief
YOU MIGHT ALSO LIKE...
;