Acute Pancreatitis: Practice Guidelines of the American College of Gastroenterology with selected updates

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Acute Pancreatitis: Practice Guidelines of the American College of Gastroenterology with selected updates"

Transcription

1 Acute Pancreatitis: Practice Guidelines of the American College of Gastroenterology with selected updates Martin L. Freeman, M.D. Professor of Medicine President Elect, American Pancreatic Association Interim Director, Division of GI, Hepatology and Nutrition Medical Director, Total Pancreatectomy / Islet Auto Transplantation University of Minnesota 1

2 ACG guidelines Published in 2006, reasonably up to date However many developments have led to updates in progress: APA: interventions for necrotizing pancreatitis, 2011 APA/IAP: evidence based guidelines for the management of acute pancreatitis, 2012 UPDATES: Interventions for Necrotizing Pancreatitis: Summary of a Multidisciplinary Consensus Conference Held at the American Pancreatic Association Meetings 3 November, 2010 Chicago, Illinois Martin Freeman MD, Jens Werner MD, Hjalmar vansantvoort MD PhD, Todd Baron MD, Marc Besselink MD PhD, Santhi Swaroop Vege MD* *and an international multidisciplinary panel of speakers and moderators PANCREAS 2012, IN PRESS 2

3 Complex pancreaticobiliary disease management Advanced Endoscopy TEAM APPROACH Hospitalists Critical Care Services Surgery Interventional Radiology 3

4 Understand the lingo Understanding current terminology The key to understanding management Call it the right name, you will do the right thing Call it the wrong name.. Acute pancreatitis How is it defined? What are the causes? How is severity assessed? Medical management? Intervention endoscopic, surgical, IR? 4

5 Defining acute pancreatitis 2 of 3 criteria: Abdominal pain and/or Amylase or lipase >3x above normal and/or Pancreatic inflammation by imaging CT (MRI, EUS) Causes of elevated amylase/lipase Pancreatic Acute pancreatitis Chronic pancreatitis Pancreatic ascites Pancreatic cancer Pseudocyst Non-pancreatic Salpingitis Salivary adenitis Burns End-stage renal disease Upper endoscopy Ischemic bowel Bowel obstruction Acute cholecystitis Macroamylasemia Macrolipasemia 5

6 Acute vs chronic pancreatitis Acute pancreatitis: Reversible inflammation Amylase/lipase usually elevated Easy to diagnose! Chronic pancreatitis Irreversible changes Amylase/lipase often normal Maybe difficult to diagnose! Much overlap! Acute pancreatitis How is it defined? What are the causes? How is severity assessed? Medical management? Intervention endoscopic, surgical, IR? Banks, Freeman Am J Gastro

7 What should you do to evaluate etiology of initial episode? History Alcohol Gallstones Medicines Systemic illnesses Trauma Family history Abdominal ultrasound Liver chemistries Serum Ca++, TG Banks, Freeman Am J Gastro 2006 Pancreaticobiliary imaging Traditional Ultrasound CT scan ERCP Newer Endoscopic ultrasound (EUS) MRCP (secretin-stimulated) 7

8 Acute pancreatitis How is it defined? What are the causes? How is severity assessed? Medical management? Intervention endoscopic, surgical, IR? Banks, Freeman Am J Gastro 2006 Severe Pancreatitis 20% of pancreatitis admissions Presence of organ failure Circulatory Pulmonary Renal Local complications Necrosis Abscess Pseudocyst Banks, Freeman Am J Gastro

9 Definitions Systemic Inflammatory Response Syndrome (SIRS) >2 Following Criteria: Pulse >90 beats/min Respiratory rate >20/min or PCO2 <32 mmhg Rectal temperature <36 C or >38 C White blood count <4,000 or >12,000/mm3 Organ Failure Organ Failure (Atlanta Symposium 1993) Shock systolic pressure <90 mmhg PaO2 60 mmhg Creatinine >2.0 mg/l after rehydration Gastrointestinal bleeding >500 cc/24 h Banks, Freeman Am J Gastro

10 Classically used Atlanta Definitions Now undergoing revision Bradley EL 3rd. A clinically based classification system for acute pancreatitis. Summary of the International Symposium on Acute Pancreatitis, Atlanta, GA, September 11 through 13, Arch Surg 1993;128: Atlanta Definitions 1993 are classic Now undergoing revision (In press, GUT) REVISED DEFINITIONS (AS OF 2012) <4 weeks Acute fluid collections (AFC), which arise in the setting of interstitial pancreatitis, are adjacent to the pancreas, homogeneous, fluid-filled and without full encapsulation. They are present less than 4 weeks after onset of AP; Acute necrotic collections (ANC), which occur in necrotizing pancreatitis, can be intra- or extra-pancreatic, heterogeneous, contain solid material with varying amounts of fluid and are without full encapsulation. They are present less than 4 weeks after onset of AP; 10

11 Atlanta Definitions 1993 are classic Now undergoing revision (In press, GUT) REVISED DEFINITIONS (AS OF 2012) Cont. >4 weeks Pseudocysts, which usually develop adjacent to the pancreas, are homogeneous, fluid-filled, with a defined wall, lack significant solid debris, and are present at least 4 or more weeks after onset of AP; Walled off necrosis (WON) which occurs only in the context of acute necrotizing pancreatitis, can be intraor extra-pancreatic, is heterogeneous, contains solid material with varying amounts of fluid, and has an encapsulating wall. This definition is usually applied 4 or more weeks after onset of AP. Interstitial Pancreatitis Pancreatic perfusion preserved 11

12 Pancreatic & peripancreatic necrosis SPECTRUM. Pancreatic perfusion compromised Necrotizing pancreatitis (pancreatic or peripancreatic) Pancreatic perfusion compromised 12

13 Revised Atlanta Definitions Necrotizing pancreatitis is defined by lack of enhancement of pancreatic parenchyma on cross-sectional imaging following intravenous contrast administration, and can involve either pancreatic parenchyma alone (rarely), pancreatic parenchyma and peripancreatic tissues (most commonly), or peripancreatic tissues alone (least commonly). Necrotizing pancreatitis 15 % of hospital admissions Severe, life-threatening Mortality 17 %, up to 30% if infected Non-enhanced areas on CT Requires IV contrast MRI nearly as good Pancreatic duct disruptions common Often requires EVACUATION Banks, Freeman Am J Gastro

14 Infected Necrosis Infected Necrosis Gas bubble on CT in 20-55% Suspect with acute clinical deterioration, fever Typically >2-3 weeks after presentation Klebsiella / E. coli / Staph aureus / Fungus Very rarely now, CT/US guided FNA required Mortality 30%, ~100% if not treated Usually requires URGENT EVACUATION! 14

15 Subacute onset Peripancreatic Often later in disease Mortality/morbidity low Requires drainage! Pancreatic Abscess (classic Atlanta term) Acute pancreatic fluid collection (classic Atlanta term) Early in disease course (<4 weeks) Lack wall of fibrous or granulation tissue Serous or exudative May or may not communicate with PD 85 % resolve spontaneously fluid pancreas 15

16 Pseudocyst >4 weeks after disease onset Localized enzyme rich fluid collection Walled off granulation tissue, no epithelium 85 % resolve spontaneously in acute pancreatitis Walled-off necrosis (pancreatic or peripancreatic) Also >4 weeks after disease onset Differs from pseudocyst in content + approach Dead pancreas, semisolid or solid necrotic tissue 16

17 Necrosis (pancreatic or peripancreatic) Main problems arise from mistaking Pseudocyst (Liquid contents, usually outside pancreas) with Walled off ( organized ) necrosis (Necrotic tissue and debris) Banks, Freeman Am J Gastro

18 Hemorrhagic Pancreatitis: obsolete term Pancreatic hemorrhage: specific term Assessing Severity at admission Bedside Assessment Often underestimates severe disease Ranson criteria are poor predictor, not used Banks, Freeman Am J Gastro

19 19

20 Apache II 20

21 Evolution to necrosis Admission Day 7 Acute pancreatitis How is it defined? What are the causes (in pediatric pts)? How is severity assessed? Medical management? Intervention endoscopic, surgical, IR? 21

22 Fluid resuscitation often inadequate cc/hr maintenance not adequate Multiple 1 liter fluid boluses usually required Some evidence that lactated ringer s solution superior to NS with respect to SIRS Follow serum hematocrit/hgb Lactated Ringer's solution reduces systemic inflammation compared with saline in patients with acute pancreatitis Wu BU, Hwang JQ, Gardner TH, Repas K, Delee R, Yu S, Smith B, Banks PA, Conwell DL. Clin Gastroenterol Hepatol Aug;9(8): BACKGROUND & AIMS: Aggressive fluid resuscitation is recommended for initial management of acute pancreatitis. We performed a randomized controlled trial to evaluate the impact of a goal-directed fluid resuscitation protocol on systemic inflammation in patients with acutepancreatitis. We then determined the impact of resuscitation with lactated Ringer's solution, compared with normal saline. METHODS: We performed a randomized controlled trial of 40 patients with acute pancreatitis at 3 New England hospitals from May 2009-February Patients received goal-directed fluid resuscitation with lactated Ringer's solution, goal-directed fluid resuscitation with normal saline, standard fluid resuscitation with lactated Ringer's solution, or standard fluid resuscitation with normal saline. Systemic inflammation was measured on the basis of levels of systemic inflammatory response syndrome (SIRS) and C-reactive protein (CRP) level after 24 hours. RESULTS: The volumes of fluid administered during a 24-hour period were similar among patients given goal-directed or standard fluid resuscitation (mean, 4300 vs 4600 ml, respectively; P =.87). Goal-directed resuscitation did not significantly reduce incidence of SIRS, compared with standard resuscitation (11.8% vs 13.0%, respectively; P =.85) or levels of CRP after 24 hours (87.1 vs 69.2 mg/dl, respectively; P =.75). By contrast, there was a significant reduction in SIRS after 24 hours among subjects resuscitated with lactated Ringer's solution, compared with normal saline (84% reduction vs 0%, respectively; P =.035); administration of lactated Ringer's solution also reduced levels of CRP, compared with normal saline (51.5 vs 104 mg/dl, respectively; P =.02). CONCLUSIONS: Patients with acute pancreatitis who were resuscitated with lactated Ringer's solution had reduced systemic inflammation compared with those who received saline. 22

23 Rising hct, fluid shifts and pancreatitis Extravasation of Fluid to Peritoneum Decreased Intravascular Volume HCT RISES Increased Third Space Loss Increased TNF, Trypsin, PLA2, Elastase, etc. Decreased Pancreatic Perfusion Increased Pancreatic Necrosis HALT THE CYCLE WITH FLUID!!! 23

24 Early Antibiotic Treatment for Severe Acute Necrotizing Pancreatitis: Randomized, Double Blind, Placebo-Controlled Study Dellinger et al, Annals of Surgery 2007 Double blinded, placebo controlled 100 patients enrolled from 32 Centers Meropenem vs Placebo Problems of other studies addressed! No Statistically Significant Benefit in Preventing Infection, Sepsis, Mortality. 24

25 Acute Pancreatitis Meta-analysis of Prophylactic Antibiotics Pancreatic Infection Pederozli Siano Schwartz Delcenserie Nordback Isenmann Dellinger Pooled Sepsis Pederozli Siano Schwartz Delcenserie Nordback Isenmann Dellenger Pooled Mortality Pederozli Siano Schwartz Delcenserie Nordback Isenmann Dellinger Pooled

26 Infected Necrosis OR. Laparoscopic Retroperitoneal Percutaneous NO LONGER TRUE!... Endoscopic - If infection suspected, EVACUATE! - Minimally invasive approaches shown superior to open surgery! 26

27 NO LONGER TRUE!... - Minimally invasive approaches shown superior to open surgery! 27

28 Methods Multicenter Randomized Controlled Trial 19 centers in Netherlands RANDOMIZED PTS WITH INFECTED PANCREATIC NECROSIS TO: Open Necrosectomy Laparotomy through bilateral subcostal incision Blunt removal of necrotic tissue Two large-bore drains for postoperative lavage Minimally Invasive Step-up Approach First step Percutaneous or endoscopic drainage If no clinical improvement, second drainage procedure was performed if needed after 72 hours If this was not possible VARD performed Second step Videoassisted retroperitoneal débridement (VARD) with postop lavage Video-Assisted Retroperitoneal Debridement (VARD) 28

29 Minimally invasive approach to infected necrosis is superior to open surgery with respect to short and long term morbidity! 29

30 Direct Endoscopic Necrosectomy (per-oral transluminal) EUS or conventional cystenterostomy Balloon dilation of cystenterostomy 2 or more double pigtail stents Serial balloon dilations up to 20mm Direct entry into cavity Endoscopic debridement water jets, baskets, forceps, nets, etc Nasocystic lavage optional Repeated every 1-7 days until resolved Seifert GUT 2000 Seewald Gastrointest Endosc 2005 Direct Endoscopic Necrosectomy (per-oral transluminal) 30

31 Endoscopic transluminal necrosectomy EUS puncture, dilation and stent Endoscopic transluminal necrosectomy Cavity entry 31

32 Endoscopic transluminal necrosectomy Endoscopic necrosectomy 32

33 Endoscopic necrosectomy is superior to minimally invasive surgical approach for infected necrosis with respect to morbidity and markers of inflammation, trend towards less mortality 33

34 Acute biliary pancreatitis impacted stone biliary sphincterotomy extracted stone 34

35 Banks, Freeman Am J Gastro 2006 Detection of common duct stones by various imaging techniques Acute Pancreatitis - Detection of Choledocholithiasis MRI Spiral CT BEST TEST EUS

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009

Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy. M. Arvanitakis SRBG June 2009 Endoscopy and infection: Prevention of infection during endoscopy Treatment of infection by endoscopy M. Arvanitakis SRBG June 2009 Outline Antibiotic prophylaxis during endoscopy Upper GI endoscopy Lower

More information

Management of Pancreatic Pseudocysts

Management of Pancreatic Pseudocysts Management of Pancreatic Pseudocysts C. Stefan Kénel-Pierre, MD Kings County Hospital Department of Surgery July 19, 2012 History 26M c PMHx of ETOH abuse, asthma Admitted 5/12 for worsening abd pain,

More information

Pancreatic Pseudocysts. Eric Rellinger October 3, 2012 Vanderbilt General Surgery

Pancreatic Pseudocysts. Eric Rellinger October 3, 2012 Vanderbilt General Surgery Pancreatic Pseudocysts Eric Rellinger October 3, 2012 Vanderbilt General Surgery Overview - Pancreatitis (Acute, Necrotizing, Chronic) - Pancreatic Pseudocysts - Clinical Presentation - Diagnostic Evaluation

More information

Surgical Management of Necrotizing Pancreatitis

Surgical Management of Necrotizing Pancreatitis Surgical Management of Necrotizing Pancreatitis The past is only the present become invisible and mute. -M. Webb James Cromie 8/16/10 Background: Acute Pancreatitis 250,000 hospitalizations annually >

More information

Research Article Analysis of the Power of Common Diagnostic Tools in the Management of Acute Pancreatitis

Research Article Analysis of the Power of Common Diagnostic Tools in the Management of Acute Pancreatitis Gastroenterology Research and Practice, Article ID 438697, 4 pages http://dx.doi.org/10.1155/2014/438697 Research Article Analysis of the Power of Common Diagnostic Tools in the Management of Acute Pancreatitis

More information

Surgical Management of Acute Pancreatitis

Surgical Management of Acute Pancreatitis Surgical Management of Acute Pancreatitis Steven J. Hughes, MD, FACS Cracchiolo Family Professor of Surgery and Chief, General Surgery Overview Biliary pancreatitis a cost effective algorithm Key concepts

More information

Joint Trust Management of Acute Severe Pancreatitis in Adults

Joint Trust Management of Acute Severe Pancreatitis in Adults A clinical guideline recommended for use In: All clinical areas (as a reference for screening) ITU/HDU (for definitive care) By: For: Key words: Written by: Supported by: Approved by: Reported as approved

More information

Pathway for the Management of Acute Gallstone Diseases

Pathway for the Management of Acute Gallstone Diseases Pathway for the Management of Acute Gallstone Diseases What s in this document? Pathways to encourage safer, faster and more cost effective management of acute gallstone (GS) disease by stratification

More information

Assessment & Management of Acute Pancreatitis

Assessment & Management of Acute Pancreatitis Assessment & Management of Acute Pancreatitis Huey Cheah Resident Rounds Oct 21, 2004 Case Study: Mr. TR Mr. TR 55 y/o male, taxi driver presents to ED with 8 hr h/o severe epigastric pain radiating to

More information

Pancréatite Aiguë Prise en charge en 2009. L Bühler. Service de Chirurgie Viscérale et Transplantation Département de Chirurgie HUG

Pancréatite Aiguë Prise en charge en 2009. L Bühler. Service de Chirurgie Viscérale et Transplantation Département de Chirurgie HUG Pancréatite Aiguë Prise en charge en 2009 L Bühler Service de Chirurgie Viscérale et Transplantation Département de Chirurgie HUG BACKGROUND Necrotizing acute pancreatitis remains a challenging clinical

More information

BILIARY TRACT DISORDERS, GALLBLADDER DISORDERS AND GALLSTONE PANCREATITIS

BILIARY TRACT DISORDERS, GALLBLADDER DISORDERS AND GALLSTONE PANCREATITIS BILIARY TRACT DISORDERS, GALLBLADDER DISORDERS AND GALLSTONE PANCREATITIS By Young Choi, M.D. & William B. Silverman, M.D. FACG Division of Gastroenterology / Hepatology University of Iowa Hospitals and

More information

Practice Guidelines in Acute Pancreatitis

Practice Guidelines in Acute Pancreatitis American Journal of Gastroenterology ISSN 0002-9270 C 2006 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2006.00856.x Published by Blackwell Publishing Practice Guidelines in Acute Pancreatitis

More information

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy

The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy The Sepsis Puzzle: Identification, Monitoring and Early Goal Directed Therapy Cindy Goodrich RN, MS, CCRN Content Description Sepsis is caused by widespread tissue injury and systemic inflammation resulting

More information

American College of Gastroenterology Guideline: Management of Acute Pancreatitis

American College of Gastroenterology Guideline: Management of Acute Pancreatitis PRACTICE GUIDELINES nature publishing group 1 American College of Gastroenterology Guideline: Management of Acute Pancreatitis Scott Tenner, MD, MPH, FACG1, John Baillie, MB, ChB, FRCP, FACG 2, Joh n D

More information

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose

Acute Abdominal Pain following Bariatric Surgery. Disclosure. Objectives 8/17/2015. I have nothing to disclose Acute Abdominal Pain following Bariatric Surgery Kathy J. Morris, DNP, APRN, FNP C, FAANP University of Nebraska Medical Center College of Nursing Disclosure I have nothing to disclose Objectives Pathophysiology

More information

Management of Acute, Severe Pancreatitis Lisa Ferrigno, MD, MPH

Management of Acute, Severe Pancreatitis Lisa Ferrigno, MD, MPH Management of Acute, Severe Pancreatitis Lisa Ferrigno, MD, MPH Management of Acute Pancreatitis: Outline Epidemiology Spectrum of Disease Early management controversies: Nutrition Role of ERCP Antibiotics

More information

Pancreatitis: scope workshop discussions Group 1 Date: 14 June 2016

Pancreatitis: scope workshop discussions Group 1 Date: 14 June 2016 Pancreatitis: scope workshop discussions Group 1 1.1. Who is the focus: The DH remit is for the diagnosis and management of Paediatrics: Very rare instances of chronic pancreatitis as the child would not

More information

Chronic Pancreatitis

Chronic Pancreatitis Chronic Pancreatitis Dhiraj Yadav, MD MPH Associate Professor Division of Gastroenterology & Hepatology University of Pittsburgh Medical Center August 18, 2013 Acute Pancreatitis Acute Inflammatory condition

More information

Colocutaneous Fistula. Disclosures

Colocutaneous Fistula. Disclosures Colocutaneous Fistula Madhulika G. Varma MD Associate Professor Chief, Colorectal Surgery University of California, San Francisco Honoraria Applied Medical Covidien Disclosures 1 Colocutaneous Fistula

More information

Revised JPN Guidelines for the Management of Acute Pancreatitis: JPN Guidelines 2015

Revised JPN Guidelines for the Management of Acute Pancreatitis: JPN Guidelines 2015 the WFSICCM Seoul 2015 2015.8,29 Seoul, Korea Revised JPN Guidelines for the Management of Acute Pancreatitis: JPN Guidelines 2015 Toshihiko 一宮市立市民病院 Mayumi 1), Tadahiro 救命救急センター Takada 2), Masamichi Yokoe

More information

Gallbladder and Bile Duct Surgery (Cholecystectomy and Common Duct Exploration) A simple guide to help answer your questions

Gallbladder and Bile Duct Surgery (Cholecystectomy and Common Duct Exploration) A simple guide to help answer your questions Gallbladder and Bile Duct Surgery (Cholecystectomy and Common Duct Exploration) A simple guide to help answer your questions What is a gallbladder? The gallbladder is the organ in the body which is responsible

More information

Therapeutic Endoscopy. Fantastic Voyage Now a Reality Robert Luís Pompa, MD Gastroenterology

Therapeutic Endoscopy. Fantastic Voyage Now a Reality Robert Luís Pompa, MD Gastroenterology Therapeutic Endoscopy Fantastic Voyage Now a Reality Robert Luís Pompa, MD Gastroenterology History of Endoscopy Two major obstacles: The gut is not straight It s dark in there! Dr. Kussmaul 1868 first

More information

Management of Bile Duct Problems Treatment Overview

Management of Bile Duct Problems Treatment Overview Management of Bile Duct Problems Treatment Overview Bile Duct Obstruction Bile duct (or biliary) obstruction occurs for numerous reasons. Causes can include cancerous and non-cancerous processes as well

More information

Amylase and Lipase Tests

Amylase and Lipase Tests Amylase and Lipase Tests Also known as: Amy Formal name: Amylase Related tests: Lipase The Test The blood amylase test is ordered, often along with a lipase test, to help diagnose and monitor acute or

More information

Acute abdominal conditions Key Points

Acute abdominal conditions Key Points 7 Acute abdominal conditions Key Points 7.1 ASSESSMENT AND DIAGNOSIS Referred abdominal pain Fore gut pain (stomach, duodenum, gall bladder) is referred to the upper abdomen Mid gut pain (small intestine,

More information

CELLULITIS. Cellulitis is a common presentation to the Emergency Department.

CELLULITIS. Cellulitis is a common presentation to the Emergency Department. CELLULITIS Introduction Cellulitis is a common presentation to the Emergency Department. The term cellulitis refers to an uncomplicated non-necrotizing acute infection of the skin that involves the mid

More information

Acute pancreatitis represents a. Management of the critically ill patient with severe acute pancreatitis

Acute pancreatitis represents a. Management of the critically ill patient with severe acute pancreatitis Special Article Management of the critically ill patient with severe acute pancreatitis Avery B. Nathens, MD, PhD; J. Randall Curtis, MD, MPH; Richard J. Beale, MBBS; Deborah J. Cook, MD; Rui P. Moreno,

More information

Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9

Omega-3 fatty acids improve the diagnosis-related clinical outcome. Critical Care Medicine April 2006;34(4):972-9 Omega-3 fatty acids improve the diagnosis-related clinical outcome 1 Critical Care Medicine April 2006;34(4):972-9 Volume 34(4), April 2006, pp 972-979 Heller, Axel R. MD, PhD; Rössler, Susann; Litz, Rainer

More information

Necrotizing Pancreatitis: Diagnosis, Imaging, and Intervention 1

Necrotizing Pancreatitis: Diagnosis, Imaging, and Intervention 1 GASTROINTESTINAL IMAGING 1218 Note: This copy is for your personal non-commercial use only. To order presentation-ready copies for distribution to your colleagues or clients, contact us at www.rsna.org/rsnarights.

More information

Biliary Stone Disease

Biliary Stone Disease Biliary Stone Disease Delivering the best in care UHB is a no smoking Trust To see all of our current patient information leaflets please visit www.uhb.nhs.uk/patient-information-leaflets.htm You have

More information

Acute Pancreatitis, Diagnosis and Management

Acute Pancreatitis, Diagnosis and Management Acute Pancreatitis, Diagnosis and Management Tedra D. Gray, BSN, MS, ACNP-BC Sinai Health Systems Internal Medicine Department Division of Gastroenterology Acute Pancreatitis Annual incidence of pancreatitis

More information

Case 1. 79 y old woman Medical history: Diabetes insuline treatment Hypertension Obesity CABG + Pacemaker Ilocolic resection for T2 colonadenoca 2009

Case 1. 79 y old woman Medical history: Diabetes insuline treatment Hypertension Obesity CABG + Pacemaker Ilocolic resection for T2 colonadenoca 2009 Cholangitis Difficult stone management D. De Wulf AZ Delta Roeselare UZ Gent Case 1 79 y old woman Medical history: Diabetes insuline treatment Hypertension Obesity CABG + Pacemaker Ilocolic resection

More information

Acute pancreatitis can range from a mild, self-limiting disease that. Clinical practice guideline: management of acute pancreatitis REVIEW REVUE

Acute pancreatitis can range from a mild, self-limiting disease that. Clinical practice guideline: management of acute pancreatitis REVIEW REVUE REVIEW REVUE Clinical practice guideline: management of acute pancreatitis Joshua A. Greenberg, MD Jonathan Hsu, MD Mohammad Bawazeer, MD John Marshall, MD Jan O. Friedrich, MD Avery Nathens, MD Natalie

More information

AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005

AORTOENTERIC FISTULA. Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA diagnosis and management Mark H. Tseng MD Brooklyn VA Hospital February 11, 2005 AORTOENTERIC FISTULA Aortoenteric

More information

The Diagnosis and Management of Gallstones in the Elderly

The Diagnosis and Management of Gallstones in the Elderly Liver Diseases The Diagnosis and Management of Gallstones in the Elderly Bao Q. Tang, MD, FRCS(C), Clinical Fellow, Minimally Invasive Surgery Program, Division of General Surgery, University Health Network,Toronto,

More information

ALS Clinical Guidelines. Recognition, Management and Prevention of Abdominal Complications of Laparoscopic Surgery

ALS Clinical Guidelines. Recognition, Management and Prevention of Abdominal Complications of Laparoscopic Surgery ALS Clinical Guidelines Recognition, Management and Prevention of Abdominal Complications of Laparoscopic Surgery Whilst laparoscopic surgery confers many advantages to patients, it has become apparent

More information

Acute pancreatitis is a common acute surgical condition.

Acute pancreatitis is a common acute surgical condition. Acute pancreatitis: update on management As acute pancreatitis is common, costly and potentially lifethreatening, it is important that management is guided by an evidencebased approach Maryam Nesvaderani

More information

A pictorial review of unusual gallstone complications

A pictorial review of unusual gallstone complications A pictorial review of unusual gallstone complications Poster No.: C-1022 Congress: ECR 2014 Type: Educational Exhibit Authors: N. J. Ley, D. M. Raw, N. Skipper; Sheffield/UK Keywords: Biliary Tract / Gallbladder,

More information

United Kingdom guidelines for the management of acute pancreatitis

United Kingdom guidelines for the management of acute pancreatitis Gut 1998;42 (suppl 2):S1 S13 S1 United Kingdom guidelines for the management of acute pancreatitis Preface These guidelines on the management of acute pancreatitis were commissioned by the British Society

More information

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation

11/10/2014. I have nothing to Disclose. Covered Stents discussed are NOT FDA approved for the indications covered in my presentation I have nothing to Disclose Ramsey Dallal, MD, FACS Vice Chair Department of Surgery Chief Bariatric i and Minimally i Invasive Surgery Einstein Healthcare Network Nemacolin, PA 2014 Covered Stents discussed

More information

Abdominal Emergency Cases. Jeff Dunkle, MD February 2011

Abdominal Emergency Cases. Jeff Dunkle, MD February 2011 Abdominal Emergency Cases Jeff Dunkle, MD February 2011 Case: Trauma Case: Trauma Dx? Dx: Shock Bowel Hypoperfusion complex Seen in patients with hypovolemic shock. Poor prognostic indicator. CT findings

More information

Sepsis and the Clinical Laboratory

Sepsis and the Clinical Laboratory Sepsis and the Clinical Laboratory Alison Woodworth, PhD Department of Pathology, Microbiology, and Immunology Vanderbilt University Medical Center Nashville, TN Learning Objectives Outline the Pathogenesis

More information

WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS

WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS WHAT S WRONG WITH MY GALL BLADDER? GALL BLADDER POLYPS This is a patient information booklet providing specific practical information about gall bladder polyps in brief. Its aim is to provide the patient

More information

Patient information regarding care and surgery associated with DIVERTICULITIS

Patient information regarding care and surgery associated with DIVERTICULITIS Patient information regarding care and surgery associated with DIVERTICULITIS by: Robert K. Cleary, M.D., John C. Eggenberger, M.D., Amalia J Stefanou, M.D. location: Michigan Heart & Vascular Institute,

More information

Overview. Assessment - types of pain. Assessment - types of pain. Assessment physical exam. Assessment physical exam. Gastrointestinal Emergencies

Overview. Assessment - types of pain. Assessment - types of pain. Assessment physical exam. Assessment physical exam. Gastrointestinal Emergencies Gastrointestinal Emergencies Emergency Nursing Core Curriculum Acknowledgement is made to the following expert for the development of this module: Karen Belotti, RN, BSN 007 Reviewed /00 by Valerie Rivituso,

More information

Advanced Practice Provider Academy

Advanced Practice Provider Academy (+)Dean T. Harrison, MPAS,PA C,DFAAPA Director of Mid Level Practitioners; Assistant Medical Director Clinical Evaluation Unit, Division of Emergency Medicine, Department of Surgery, Duke University Medical

More information

Digestive System. Coding Tips Digestive Conditions. Diverticulosis and Diverticulitis

Digestive System. Coding Tips Digestive Conditions. Diverticulosis and Diverticulitis Codes for gastrointestinal (GI) disorders are located in chapter 11 (Diseases of the Digestive System). This section of the Navigator discusses several GI conditions frequently encountered in radiology,

More information

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS

PATIENT CONSENT TO PROCEDURE - ROUX-EN-Y GASTRIC BYPASS As a patient you must be adequately informed about your condition and the recommended surgical procedure. Please read this document carefully and ask about anything you do not understand. Please initial

More information

UCLA Asian Liver Program

UCLA Asian Liver Program CLA Program Update Program Faculty Myron J. Tong, PhD, MD Professor of Medicine Hepatology Director, Asian Liver Program Surgery Ronald W. Busuttil, MD, PhD Executive Chair Department of Surgery Director,

More information

ENABLING PATIENTS WITH PANCREATITIS TO LIVE LIFE TO THE FULLEST

ENABLING PATIENTS WITH PANCREATITIS TO LIVE LIFE TO THE FULLEST ENABLING PATIENTS WITH PANCREATITIS TO LIVE LIFE TO THE FULLEST Two decades ago the outlook for patients with pancreatitis was grim. But within the last decade and a half, major advances have been made

More information

The Management of Acute Abdominal Pain in Children with Sickle Cell Disease

The Management of Acute Abdominal Pain in Children with Sickle Cell Disease The Management of Acute Abdominal Pain in Children with Sickle Cell Disease Document Information Version: 2 Date: 30 th December 2013 Authors (incl. job title): Professor David Rees Paediatric Haematologist)

More information

Bile Leaks After Laparoscopic Cholecystectomy. Kings County Hospital Center Eliana A. Soto, MD

Bile Leaks After Laparoscopic Cholecystectomy. Kings County Hospital Center Eliana A. Soto, MD Bile Leaks After Laparoscopic Cholecystectomy Kings County Hospital Center Eliana A. Soto, MD Biliary Injuries during Cholecystectomy In the 1990s, high rate of biliary injury was due in part to learning

More information

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:.

Acute Pancreatitis. Questionnaire. if yes: amount (cigarettes/day): since when (year): Drug consumption: yes / no if yes: type of drug:. amount:. The physical examination has to be done AT ADMISSION! The blood for laboratory parameters has to be drawn AT ADMISSION! This form has to be filled AT ADMISSION! Questionnaire Country: 1. Patient personal

More information

Core Measures SEPSIS UPDATES

Core Measures SEPSIS UPDATES Patricia Walker, RN-BC, BSN Evidence Based Practice Manager Quality Management Services UCLA Health System, Ronald Reagan Medical Center Core Measures SEPSIS UPDATES Sepsis Core Measures Bundle Requirements

More information

The Whipple Procedure. Sally Hodges, Ph.D.(c) Given the length and difficulty of the procedure, regardless of the diagnosis, certain

The Whipple Procedure. Sally Hodges, Ph.D.(c) Given the length and difficulty of the procedure, regardless of the diagnosis, certain The Whipple Procedure Sally Hodges, Ph.D.(c) Preoperative procedures Given the length and difficulty of the procedure, regardless of the diagnosis, certain assurances must occur prior to offering a patient

More information

Emergencies in Post- Bariatric Surgery Patients

Emergencies in Post- Bariatric Surgery Patients Emergencies in Post- Patients Disclosures Dr. Birnbaumer has no financial disclosures Diane M. Birnbaumer, M.D., FACEP Professor of Medicine University of California, Los Angeles Senior Clinical Educator

More information

Risk stratification tool for children aged under 5 years with suspected sepsis

Risk stratification tool for children aged under 5 years with suspected sepsis Risk stratification tool for children aged under 5 years with suspected sepsis Category Age Behaviour No response to social cues Appears ill to a healthcare professional Does not wake, or if roused does

More information

Acute on Chronic Liver Failure: Current Concepts. Disclosures

Acute on Chronic Liver Failure: Current Concepts. Disclosures Acute on Chronic Liver Failure: Current Concepts Vandana Khungar, MD MSc Assistant Professor of Medicine University of Pennsylvania, Perelman School of Medicine September 20, 2015 None to declare Disclosures

More information

Cholecystectomy for acute gallstone pancreatitis: early vs delayed approach

Cholecystectomy for acute gallstone pancreatitis: early vs delayed approach Scandinavian Journal of Surgery 99: 81 85, 2010 Cholecystectomy for acute gallstone pancreatitis: early vs delayed approach C. T. Wilson, M. A. de Moya Department of Trauma, Emergency Surgery, and Critical

More information

Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery

Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery Facing Pancreatic Surgery? Learn about minimally invasive da Vinci Surgery The Condition: Pancreatitis/Pancreatic Cancer The pancreas is an organ that produces enzymes and hormones to help your body digest

More information

Cystic Neoplasms of the Pancreas: A multidisciplinary approach to the prevention and early detection of invasive pancreatic cancer.

Cystic Neoplasms of the Pancreas: A multidisciplinary approach to the prevention and early detection of invasive pancreatic cancer. This lecture is drawn from the continuing medical education program Finding Hope: Prevention, Early Detection and Treatment of Pancreatic Cancer, Nov, 2011. Robert P. Jury, MD Cystic Neoplasms of the Pancreas:

More information

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series

ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy. Case Series ABThera Open Abdomen Negative Pressure Therapy for Active Abdominal Therapy Case Series Summary of Cases: USER EXPERIENCE The ABThera OA NPT system was found by surgeons to be a convenient and effective

More information

Gallbladder - gallstones and surgery

Gallbladder - gallstones and surgery Gallbladder - gallstones and surgery Summary Gallstones are small stones made from cholesterol, bile pigment and calcium salts, which form in a person s gall bladder. Medical treatment isn t necessary

More information

Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder.

Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder. Gallbladder cancer Gallbladder cancer is a disease in which malignant (cancer) cells form in the tissues of the gallbladder. Gallbladder cancer is a rare disease in which malignant (cancer) cells are found

More information

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma

To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma August 2009 To Whipple or Not to Whipple, that is the Question: Evaluating the Resectability of Pancreatic Adenocarcinoma Christina Ramirez, Harvard Medical School Year III Gillian Lieberman, MD Agenda

More information

Surgery Symposium 2012

Surgery Symposium 2012 Surgery Symposium 2012 The Complex Ventral Hernia: How to patch a Hole When It s Bigger Than Your Finger April 28, 2012 Travis Littman MD Winnie Henderson MD PhD Northwest Surgical Specialists, LLP No

More information

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds

Laparoscopic Repair of Incisional Hernia. Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Laparoscopic Repair of Incisional Hernia Maria B. ALBUJA-CRUZ, MD University of Colorado Department of Surgery-Grand Rounds Overview Definition Advantages of Laparoscopic Repair Disadvantages of Open Repair

More information

Abdominal pain. Agnieszka Dobrowolska- Zachwieja, MD, PhD Department of Gastroenterology and Human Nutrition

Abdominal pain. Agnieszka Dobrowolska- Zachwieja, MD, PhD Department of Gastroenterology and Human Nutrition Abdominal pain Agnieszka Dobrowolska- Zachwieja, MD, PhD Department of Gastroenterology and Human Nutrition Most common symptoms of abdominal disease Pain Nausea and/or vomiting Change in bowel movements

More information

Complications of pediatric endoscopy and colonoscopy. Informed consent. Learning objectives. Complication types. Complications (adults) 10/3/2012

Complications of pediatric endoscopy and colonoscopy. Informed consent. Learning objectives. Complication types. Complications (adults) 10/3/2012 Complications of pediatric endoscopy and colonoscopy I have no financial relationships with any commercial entity to disclose Petar Mamula, M.D. The Children s Hospital of Philadelphia University of Pennsylvania

More information

Early evaluation of the abdomen is a challenging component of the initial assessment of the

Early evaluation of the abdomen is a challenging component of the initial assessment of the Focused Issue of This Month Emergency Care of Abdominal Trauma Kyoung Soo Lim, MD Department of Emergency Medicine, Ulsan University of College of Medicine Email : kslim@amc.seoul.kr J Korean Med Assoc

More information

Open Ventral Hernia Repair

Open Ventral Hernia Repair Ventral Hernias Open Ventral Hernia Repair UCSF Postgraduate Course in General Surgery Maui, HI March 21, 2011 Hobart W. Harris, MD, MPH Ventral Hernias: National Experience Occur following 11-23% of laparotomies,

More information

Abdominal Mass Patient Management Process. Janix M. De Guzman, MD Department of Surgery

Abdominal Mass Patient Management Process. Janix M. De Guzman, MD Department of Surgery Abdominal Mass Patient Management Process Janix M. De Guzman, MD Department of Surgery Abdominal Mass History Physical Examination Abdominal Mass History Onset Location acute chronic progressing Associated

More information

Diagnosis and Prognosis of Pancreatic Cancer

Diagnosis and Prognosis of Pancreatic Cancer Main Page Risk Factors Reducing Your Risk Screening Symptoms Diagnosis Treatment Overview Chemotherapy Radiation Therapy Surgical Procedures Lifestyle Changes Managing Side Effects Talking to Your Doctor

More information

The digestive system. Medicine and technology. Normal structure and function Diagnostic methods Example diseases and therapies

The digestive system. Medicine and technology. Normal structure and function Diagnostic methods Example diseases and therapies The digestive system Medicine and technology Normal structure and function Diagnostic methods Example diseases and therapies The digestive system An overview (1) Oesophagus Liver (hepar) Biliary system

More information

Center for Endoscopic Research & Therapeutics

Center for Endoscopic Research & Therapeutics Center for Endoscopic Research & Therapeutics 5758 South Maryland Avenue (MC9028) Chicago, Illinois 60637 (773) 702-1459 www.uchospitals.edu Center for Endoscopic Research & Therapeutics To refer a patient

More information

Microwave ablation for the treatment of liver metastases

Microwave ablation for the treatment of liver metastases Microwave ablation for the treatment of liver Issued: August 2011 guidance.nice.org.uk/ipg NICE has accredited the process used by the NICE Interventional Procedures Programme to produce interventional

More information

Sepsis: Identification and Treatment

Sepsis: Identification and Treatment Sepsis: Identification and Treatment Daniel Z. Uslan, MD Associate Clinical Professor Division of Infectious Diseases Medical Director, UCLA Sepsis Task Force Severe Sepsis: A Significant Healthcare Challenge

More information

Acute Appendicitis: What s New with an Old Foe?

Acute Appendicitis: What s New with an Old Foe? Acute Appendicitis: What s New with an Old Foe? UCSF Postgraduate Course in General Surgery Maui, HI March 21, 2011 Introduction Nonoperative Management Timing of Surgery Interval Appendectomy Summary

More information

Alcoholic Hepatitis (Teacher s Guide)

Alcoholic Hepatitis (Teacher s Guide) Thomas Ormiston, M.D. Updated 5/5/15 2007-2015, SCVMC Alcoholic Hepatitis (Teacher s Guide) (30 minutes) I. Objectives Recognize the signs and symptoms of alcoholic hepatitis Understand the treatment options

More information

Guide to Abdominal or Gastroenterological Surgery Claims

Guide to Abdominal or Gastroenterological Surgery Claims What are the steps towards abdominal surgery? Investigation and Diagnosis It is very important that all necessary tests are undertaken to investigate the patient s symptoms appropriately and an accurate

More information

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center

Endoscopic Management of Strictures and Leaks. Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center Endoscopic Management of Strictures and Leaks Prepared by Aurora D. Pryor, MD Presented by Dana Portenier, MD Duke University Medical Center What can go wrong? Bleeding (2%) Sleeve too big Angulated Too

More information

ERCP in Post Surgical Anatomy

ERCP in Post Surgical Anatomy ERCP in Post Surgical Anatomy ACG Western Regional Course, 2013 John G. Lee, MD Division of Gastroenterology University of California, Irvine Medical Center Common surgical alterations Intact pancreaticobiliary

More information

Gallstone Ileus. Audrey C. Durrant,, M.D. SUNY Downstate Medical Center May 20, 2005

Gallstone Ileus. Audrey C. Durrant,, M.D. SUNY Downstate Medical Center May 20, 2005 Gallstone Ileus Audrey C. Durrant,, M.D. SUNY Downstate Medical Center May 20, 2005 Gallstone Ileus Diagnosis and Management Background Misnomer coined by Bartolin in 1654 Not a true ileus True mechanical

More information

Approach to the Acute Abdomen in Resource Limited Settings

Approach to the Acute Abdomen in Resource Limited Settings Approach to the Acute Abdomen in Resource Limited Settings Christine A Babcock MD FACEP Assistant Professor Program Director University of Chicago Medicine November 6, 2014 Objectives Recognize common

More information

Gallstone Pancreatitis: When Is. procedures such as endoscopic retrograde cholangiopancreatography

Gallstone Pancreatitis: When Is. procedures such as endoscopic retrograde cholangiopancreatography Gallstone Pancreatitis: When Is Endoscopic Retrograde Cholangiopancreatography Truly Necessary? Matthias Kraft, MD and Markus M. Lerch, MD, FRCP* Address *Department of Medicine B, Westfälische Wilhelms-Universität

More information

Acute Inflammatory Surgical Disease

Acute Inflammatory Surgical Disease Acute Inflammatory Surgical Disease Peter J. Fagenholz, MD*, Marc A. de Moya, MD KEYWORDS Appendicitis Cholecystitis Cholangitis Pancreatitis Diverticulitis Clostridium difficile Colitis KEY POINTS Computed

More information

Gastrointestinal & Hepatic- Biliary Systems

Gastrointestinal & Hepatic- Biliary Systems Objectives Gastrointestinal & Hepatic- Biliary Systems Chapter 5 Part II Review the general signs & symptoms associated with lower GI pathology Discuss the common illnesses/conditions involving the lower

More information

The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome

The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Biomedical & Pharmacology Journal Vol. 6(2), 259-264 (2013) The Initial and 24 h (After the Patient Rehabilitation) Deficit of Arterial Blood Gases as Predictors of Patients Outcome Vadod Norouzi 1, Ali

More information

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany

Preoperative drainage is always indicated in malignant CBD strictures PRO. Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Preoperative drainage is always indicated in malignant CBD strictures PRO Horst Neuhaus Evangelisches Krankenhaus Düsseldorf, Germany Background Jaundice is associated with high perioperative morbidity

More information

Jaundice. Michael Ornes

Jaundice. Michael Ornes Jaundice Michael Ornes Definitions Jaundice: hyperbilirubinemia leading to yellow discoloration of the skin Icterus: hyperbilirubinemia leading to yellow discoloration of the sclera Usually undetectable

More information

Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH. Preparation for EGD, ERCP, Peg Placement.

Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH. Preparation for EGD, ERCP, Peg Placement. Gary M. Annuniziata, D.O., F.A.C.P. Anh T. Duong, M.D. Jonathan C. Lin, M.D., MPH Phone- (760) 321-2500 Fax- (760) 321-5720 Preparation for EGD, ERCP, Peg Placement Patient Name- Procedure Date and Time-

More information

Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver.

Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver. EXTRAHEPATIC BILE DUCT CANCER General Information Extrahepatic bile duct cancer is a rare disease in which malignant (cancer) cells form in the part of bile duct that is outside the liver. A network of

More information

Marginal Ulcers. Marginal Ulcers. Gastric Remnant Ulcers. Double Balloon Enteroscopy. Marginal Ulcer. Gastrojejunal Stricture.

Marginal Ulcers. Marginal Ulcers. Gastric Remnant Ulcers. Double Balloon Enteroscopy. Marginal Ulcer. Gastrojejunal Stricture. Upper Abdominal Pain in the Bariatric Surgery Patient Martin L. Freeman, M.D., FASGE,FACG Professor of Medicine Director, Pancreaticobiliary Endoscopy Fellowship Interim Director, Division of GI, Hepatology

More information

Initial Management of Acute Pancreatitis: Critical Issues During the First 72 Hours

Initial Management of Acute Pancreatitis: Critical Issues During the First 72 Hours American Journal of Gastroenterology ISSN 0002-9270 C 2004 by Am. Coll. of Gastroenterology doi: 10.1111/j.1572-0241.2004.40329.x Published by Blackwell Publishing Initial Management of Acute Pancreatitis:

More information

Acute Pancreatitis: Initial Management

Acute Pancreatitis: Initial Management Acute Pancreatitis: Initial Management Algorithm 1. Recognition and Initial Severity Assessment Presentation suggestive of acute pancreatitis Medical History Physical Exam Labs to Order Imaging Investigate:

More information

GASTROENTEROLOGY FELLOWSHIP PANCREATICOBILARY CONSULTATION SERVICE GOALS AND OBJECTIVES University of Toledo

GASTROENTEROLOGY FELLOWSHIP PANCREATICOBILARY CONSULTATION SERVICE GOALS AND OBJECTIVES University of Toledo GASTROENTEROLOGY FELLOWSHIP PANCREATICOBILARY CONSULTATION SERVICE GOALS AND OBJECTIVES University of Toledo Educational Purpose: The Pancreaticobiliary Service at UTMC introduces the fellow to inpatient

More information

Laparoscopic Cholecystectomy (Removal of the Gallbladder)

Laparoscopic Cholecystectomy (Removal of the Gallbladder) Laparoscopic Cholecystectomy (Removal of the Gallbladder) The gall bladder is a small pear-shaped organ that lies in the right upper quadrant of your abdomen under your liver (under your ribs). The liver

More information

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012.

Oxygen Therapy. Oxygen therapy quick guide V3 July 2012. PRESENTATION Oxygen (O 2 ) is a gas provided in a compressed form in a cylinder. It is also available in a liquid form. It is fed via a regulator and flow meter to the patient by means of plastic tubing

More information

ACS Don t worry. I know a hundred tricks to get this closed. G Merlotti 1988

ACS Don t worry. I know a hundred tricks to get this closed. G Merlotti 1988 ABDOMINAL COMPARTMENT SYNDROME Gary Merlotti, M.D. Chairperson,Department of Surgery Mount Sinai Medical Center ACS Don t worry. I know a hundred tricks to get this closed. G Merlotti 1988 ACS - DEFINITION

More information

Treatment Guide Pancreatic Disease CHOOSING YOUR CARE

Treatment Guide Pancreatic Disease CHOOSING YOUR CARE Treatment Guide Pancreatic Disease The pancreas is one of the body s great multi-taskers this dual-purpose organ is also a gland. Some people may not give much thought to the pancreas, especially those

More information