Annals for Hospitalists Inpatient Notes - Clinical Pearls—Acute Pancreatitis
Authors: Pramod K. Garg
Journal: Annals of Internal Medicine (2019)

Web Exclusives19 February 2019Annals for Hospitalists Inpatient Notes - Clinical Pearls—Acute PancreatitisPramod K. Garg, MDPramod K. Garg, MDAll India Institute of Medical Sciences, New Delhi, India (P.K.G.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M19-0008 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail A 54-year-old woman presented with acute-onset upper abdominal pain of moderate intensity for 12 hours. Vital signs were normal. There was mild epigastric tenderness but no mass, guarding, rigidity, or ascites. Laboratory tests showed a hematocrit of 46%, leukocyte count 12.600/µL, blood urea nitrogen 28 mg/dL, amylase 1200 IU, and lipase 2150 IU. The abdominal radiograph was normal. The chest radiograph showed small, left-sided pleural effusion. Abdominal ultrasonography revealed gallstones and an enlarged, hypoechoic pancreas. The patient was diagnosed with gallstone-induced acute pancreatitis (AP).How should the severity of this patient's AP be assessed? Is additional imaging necessary at this ...References1. Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al; Acute Pancreatitis Classification Working Group. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62:102-11. [PMID: 23100216] doi:10.1136/gutjnl-2012-302779 CrossrefMedlineGoogle Scholar2. Jain S, Midha S, Mahapatra SJ, Gupta S, Sharma MK, Nayak B, et al. Interleukin-6 significantly improves predictive value of systemic inflammatory response syndrome for predicting severe acute pancreatitis. Pancreatology. 2018. [PMID: 29779831] doi:10.1016/j.pan.2018.05.002 CrossrefMedlineGoogle Scholar3. Working Group IAP/APA Acute Pancreatitis Guidelines. IAP/APA evidence-based guidelines for the management of acute pancreatitis. Pancreatology. 2013;13:e1-15. [PMID: 24054878] doi:10.1016/j.pan.2013.07.063 CrossrefMedlineGoogle Scholar4. Vaughn VM, Shuster D, Rogers MAM, Mann J, Conte ML, Saint S, et al. Early versus delayed feeding in patients with acute pancreatitis: a systematic review. Ann Intern Med. 2017;166:883-92. [PMID: 28505667]. doi:10.7326/M16-2533 LinkGoogle Scholar5. Mouli VP, Sreenivas V, Garg PK. Efficacy of conservative treatment, without necrosectomy, for infected pancreatic necrosis: a systematic review and meta-analysis. Gastroenterology. 2013;144:333-340. [PMID: 23063972] doi:10.1053/j.gastro.2012.10.004 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: All India Institute of Medical Sciences, New Delhi, India (P.K.G.)Disclosures: The author has disclosed no conflicts of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M19-0008.Corresponding Author: Pramod K. Garg, MD, Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India; e-mail, [email protected]ac.in. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAnnals for Hospitalists - 19 February 2019 David H. Wesorick and Vineet Chopra Metrics Cited byAcute pancreatitis and nosocomial COVID-19: Cause specific host responses may determine lung injury 19 February 2019Volume 170, Issue 4Page: HO2-HO3KeywordsAcute pancreatitisAntibioticsComputed axial tomographyHospitalizationsNecrosisNutritionPancreatitisPleural effusionResuscitationUltrasound imaging ePublished: 19 February 2019 Issue Published: 19 February 2019 Copyright & PermissionsCopyright © 2019 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...