Choice of iv fluids in pancreatitis

Intravenous fluids (IVF) like normal saline (NS) and Ringer's lactate (RL) are often crucial in the management of hospitalized patients. Mishandling these fluids can lead to complications in about 20% of patients receiving them. In this review, we present the current evidence through the identification of observational studies and randomized trials that observed the optimal use of IVF. We found that NS may cause hyperchloremic metabolic acidosis in surgical patients, but there is no clear difference in mortality and long-term outcomes between NS and balanced crystalloids...

BACKGROUND: The aim of this survey was to assess practices regarding pain management, fluid therapy and thromboprophylaxis in patients undergoing pancreatoduodenectomy on a global basis. METHODS: This survey study among surgeons from eight (inter)national scientific societies was performed according to the CHERRIES guideline. RESULTS: Overall, 236 surgeons completed the survey. ERAS protocols are used by 61% of surgeons and respectively 82%, 93%, 57% believed there is a relationship between pain management, fluid therapy, and thromboprophylaxis and clinical outcomes...

PURPOSE OF REVIEW: There have been significant advancements in different aspects of management of severe acute pancreatitis (SAP). Our review of the most recent literature focuses on severity prediction, fluid resuscitation, analgesic administration, nutrition, and endoscopic intervention for SAP and its extra-pancreatic complications. RECENT FINDINGS: Recent studies on serum cytokines for the prediction of SAP have shown superior prognostic performance when compared with conventional laboratory tests and clinical scoring systems...

BACKGROUND: Splenic littoral cell angioma (LCA) is a rare vascular tumor with malignant potential originating from the red pulp of the spleen.1,2 Although laparoscopic splenectomy is the treatment choice for LCA,3 patients suffer from long-term complications of sepsis, thrombosis, and tumor.4,5 Laparoscopic central splenectomy (LCS) for LCA is a technically challenging operation mainly due to the risk of intraoperative hemorrhage. However, it can be a valuable alternative particularly for adolescent patients in whom maximum preservation of splenic function outweighs the risks associated with organ preservation...

IMPORTANCE: Morbidity is still high in pancreatic surgery, driven mainly by gastrointestinal complications such as pancreatic fistula. Perioperative thoracic epidural analgesia (EDA) and patient-controlled intravenous analgesia (PCIA) are frequently used for pain control after pancreatic surgery. Evidence from a post hoc analysis suggests that PCIA is associated with fewer gastrointestinal complications. OBJECTIVE: To determine whether postoperative PCIA decreases the occurrence of gastrointestinal complications after pancreatic surgery compared with EDA...

BACKGROUND: Acute pancreatitis is a frequent reason for patient presentation to the emergency department (ED) and the most common gastrointestinal disease resulting in admission. Emergency clinicians are often responsible for the diagnosis and initial management of acute pancreatitis. OBJECTIVE: This review article provides emergency clinicians with a focused overview of the diagnosis and management of pancreatitis. DISCUSSION: Pancreatitis is an inflammatory process within the pancreas...

RATIONALE: The usual presentation of sarcoidosis is hilar adenopathy, pulmonary reticular opacities, skin, joint, or eye lesions. Pancreatic involvement is unusual and hypercalcemic pancreatitis as initial manifestation is very rare. PATIENT CONCERNS: We present a case that presented with 1-day history of vomiting, diffuse abdominal pain, and altered mental status. DIAGNOSES: Initial investigations showed highly elevated calcium levels, acute pancreatitis, and kidney failure...

PURPOSE OF REVIEW: The obesity pandemic poses a unique set of problems for acute pancreatitis - both by increasing acute pancreatitis incidence, and worsening acute pancreatitis severity. This review explores these associations, underlying mechanisms, and potential therapies. RECENT FINDINGS: We review how the obesity associated increase in gallstones, surgical, and endoscopic interventions for obesity management, diabetes, and related medications such as incretin-based therapies and hypertriglyceridemia may increase the incidence of acute pancreatitis...

UNLABELLED: Early detection of infection in acute pancreatitis (AP) affects the choice of treatment and clinical outcome. We used PET/CT with (18)F-FDG-labeled autologous leukocytes to detect infection in pancreatic or peripancreatic fluid collections in patients with AP. METHODS: Forty-one patients (28 men and 13 women) who were 21-69 y old (mean ± SD, 41 ± 11.5) and had AP and radiologic evidence of a fluid collection in or around the pancreas were studied. Leukocytes were separated from the patient's venous blood, labeled with (18)F-FDG, and reinjected intravenously; PET/CT images were acquired 2 h later...

BACKGROUND: Electrocardiographic abnormalities mimicking myocardial ischemia have been reported in intra-abdominal conditions, including acute pancreatitis. However, the occurrence of ST-elevation myocardial infarction (STEMI) is rare. OBJECTIVES: To present a case report of a young man with acute pancreatitis subsequently complicated by acute STEMI. The diagnosis and management of STEMI in acute pancreatitis can present unique diagnostic and therapeutic challenges, which are reviewed...

When a diagnosis of acute pancreatitis (AP) is made, fundamental medical treatment consisting of fasting, intravenous (IV) fluid replacement, and analgesics with a close monitoring of vital signs should be immediately started. In parallel with fundamental medical treatment, assessment of severity based on clinical signs, blood test, urinalysis and imaging tests should be performed to determine the way of treatment for each patient. A repeat evaluation of severity is important since the condition is unstable especially in the early stage of AP...

In about 95% of patients with acute cholecystitis the cystic duct is obstructed by a gall stone. The imprisoned bile salts have a toxic action on the gall bladder wall. Acute cholecystitis is liable to be confused with other causes of sudden pain and tenderness in the right hypochondrium. Below the diaphragm, acute retrocecal appendicitis, intestinal obstruction, a perforated peptic ulcer or acute pancreatitis may be confusing factors; however, the gall bladder remains shrunken, fibrotic, full of stones and nonfunctioning...

The objective of this study has been to lay the groundwork for a re-evaluation of the place of antibiotics in acute pancreatitis. This section has been devoted to determining if antibiotics excreted by the normal pancreas are excreted similarly in acute pancreatitis. Ten mongrel dogs were studied, each acting as its own control. Day 1: Operation--construction of pancreatic fistula. Day 2: Study of antibiotic excretion. Day 14: Operation--induction of acute focal pancreatitis. Day 15: Study of antibiotic excretion...

Crevicular fluid samples were collected from 20 gingivitis and periodontitis patients using filter paper strips; these were then eluted into buffer. Portions of each sample were combined and the activities of this pooled eluate against different peptidyl derivatives of 7-amino-4-trifluoromethyl coumarin (AFC) were examined with respect to their pH profiles and effector responses. Ca-thepsin B- and L-like activity was detected with Bz-Val-Lys-Lys-Arg-AFC; elastase-like activity with MeOSuc-Ala-Ala-Pro-Val-AFC; tryptase-like activity with Z-Ala-Ala-Lys-AFC; trypsin-like activity with Z-Gly-Gly-Arg-AFC; and dipeptidyl peptidase (DPP) IV-like activity with Ala-Pro-AFC...