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Management of Pancreatitis at NMUH

Management of Pancreatitis at NMUH. Chris Bretherton Surgical FY1. Audited against UK guidelines for the management of acute pancreatitis from British Society of Gastroenterology – GUT 2005. What I did.

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Management of Pancreatitis at NMUH

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  1. Management of Pancreatitis at NMUH Chris Bretherton Surgical FY1 Audited against UK guidelines for the management of acute pancreatitis from British Society of Gastroenterology – GUT 2005

  2. What I did Obtained a list of patients with diagnosis of acute pancreatitis from April 2011 – April 2012 Went through the notes to determine were patients : • Being scored on admission • Being scored appropriately • Being rescored with 48hours of admission • Receiving abdominal Ultrasound Scan within 24 hours • Receiving timely ERCP as appropriate • Having definite management of Gall stone disease (Laparoscopic Cholecystectomy)

  3. Glasgow Score • P – O2 <8 kPa • A – ge >55 • N – eutrophilia – WCC >15 x 109/LC – alcium <2 mmol/L • R – aised Urea >16 mmol/L • E – nzymes – LDH >600 units/L AST > 100 units • A – lbumin < 32 g/L • S – ugar – Blood glucose > 10mmol/L (non diabetics)

  4. Severity Scoring Severity stratification should be made in all patients within 48 hours of diagnosis

  5. Ultrasound Radiological facilities should be available to permit ultrasound examination of the gall bladder within 24 hours of diagnosis of acute pancreatitis.

  6. Management of Gallstone Pancreatitis Urgent therapeutic endoscopic retrograde cholangiopancreatography(ERCP) should be performed in patients with acute pancreatitis of suspected or proven gall stoneaetiology who satisfy the criteria for predicted or actual severepancreatitis, or when there is cholangitis, jaundice, or a dilated common bile duct. The procedure is best carried out within the first 72 hours after the onset of pain. All patients undergoing early ERCP for severe gallstone pancreatitis require endoscopic sphincterotomy whether or not stones are found in the bile duct (recommendation grades B and C).

  7. Management of Gallstone Pancreatitis

  8. May 2012 – July 2012

  9. All patients with Biliary Pancreatitis should undergo definitive management of gall stones during the same hospital admission, unless a clear plan has been made for definitive treatment within the next two weeks (recommendation grade C).

  10. Proforma Aims • 1 – All patients should be severity scored on admission and within 48 hours • 2 – All suitable patients should be considered for ERCP • 3 – All patients with Gallstone Pancreatitis should have a Laparoscopic Cholecystectomy booked before discharge

  11. Average length of stay 6.6 days (0-47) (Mode 3) (Median 5) 132 cases from April 2011-2012 10 recurrent (excluding obviously chronic pancreatitis) – of which 1 person recurred 2 x • Questions? • Comments? • Thank you

  12. Causes of Pancreatitis The aetiology of acute pancreatitis should be determined in at least 80% of cases and no more than 20% should be classified as idiopathic (recommendation grade B)

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