Pancreatitis 

• Causes – IGETSMASHED
  • Idiopathic
  • Gallstones
  • EtoH
  • Trauma
  • Steroids
  • mumps/malignancy
  • autoimmune
  • scorpion
  • hypertriglycerides/calcaemi
  • ERCP
  • Drugs (HCTZ, bactrim, azathioprine)

Prognostic criteria

Ranson’s (valid for ETOH-induced pancreatitis only)

• Glasgow (includes gallstones and ETOH-induced)
• PaO2 <8kPa
• Age >55
• Neutrophils WCC >16
• Ca <2mmol/L
• Renal fx: Urea >16mmol/L
• Enzymes LDH > 600, AST >200
• Albumin >32g/L
• Sugar >10mmol/L

Mx

• Fluids, fluids, fluids (IV, both crystalloid + colloid + NBM)
• Intense monitoring
• Analgesia (meperidine, not morphine)
• Correct hypoxia
• Nutrition (pancreatitis is hypercatabolic) NG tube/TPN
• Antibiotic prophylaxis
• Surgery only if complications (e.g. pseudocyst  drainage) or if gallstones cause.