ASGE Annual GI Advanced Practice Provider Course - Day Two (On-Demand) | April 2022-22_ Pancreas Case Studies

22_ Pancreas Case Studies - Enslin

Pdf Summary

This document is a case-based discussion on acute pancreatitis (AP). The case presented is about a 45-year-old male with acute onset severe epigastric pain. The patient has a history of GERD, diabetes, laparoscopic fundoplication, and current medication use of sitagliptin and pantoprazole. The patient's labs showed elevated lipase, and an abdominal ultrasound revealed cholelithiasis.<br /><br />The discussion provides an overview of AP, stating that it is an inflammatory disorder of the pancreas and peri-pancreatic tissues, and the leading cause of GI hospitalizations in the US. The causes of AP include gallstones, alcohol, post-ERCP, hypertriglyceridemia, autoimmune factors, medications, hypercalcemia, trauma, and idiopathic factors. Medication-induced AP is rare but can occur, and discontinuing the causative medication is recommended.<br /><br />The work-up for AP involves evaluating liver function tests, triglyceride levels, IgG4 levels, renal function tests, calcium levels, hematocrit, white blood cell count, and monitoring for systemic inflammatory response syndrome (SIRS). The management of AP includes hospital admission, nil per os (NPO) status, aggressive intravenous fluid hydration, analgesics, anti-emetics, monitoring of urine output and laboratory values, and consideration of enteral nutrition if unable to tolerate oral intake. Specific interventions, such as ERCP, may be required based on the cause of pancreatitis.<br /><br />The severity of AP is classified as mild, moderately severe, or severe based on the presence and duration of organ failure. Various prognostic scoring systems exist but have limitations. Severe AP may require ICU care and has a higher mortality risk. The case of LS in the document was managed with supportive care, and the patient showed rapid improvement and was discharged home.<br /><br />The document also discusses recurrent AP and its potential causes, such as pancreas divisum, hereditary pancreatitis, autoimmune pancreatitis, and choledocholithiasis/microlithiasis. The management of complications like pancreatic pseudocysts and pancreatic necrosis is also discussed, including observation, drainage procedures, and surgical interventions if symptomatic or infected.<br /><br />Other topics covered in the document include the timing of cholecystectomy in gallstone pancreatitis and the diagnosis and treatment of autoimmune pancreatitis. The take-home points from the discussion include the increasing incidence of AP, the role of ERCP in cholangitis, the limited utility of prognostic scoring systems, and the importance of early diagnosis and supportive care in the management of AP.

Keywords

acute pancreatitis

epigastric pain

GERD

cholelithiasis

medication-induced AP

ERCP

prognostic scoring systems

pancreatic pseudocysts

cholecystectomy

autoimmune pancreatitis