Acute Pancreatitis - Pancreatic Pathologies by the Pancreas Care Center at CCHMC

GlobalCast MD along with Cincinnati Children's Hospital sharing knowledge to improve child health around the globe. Welcome to our educational videos about pancreatic pathologies by the Pancreas Care Center at Cincinnati Children's Hospital. Today, we are talking about acute pancreatitis, and for that, we have three experts from the Pancreas Care Center, Dr. Maisam Abu-El-Aita, the director of the Pancreas Care Center, Dr. Andrew Trout, professor of radiology and director of clinical research for radiology, and Dr. Juan Guerra, the surgical director of the Pancreas Care Center and surgical critical care. So let's start from the beginning. What is acute pancreatitis? It is an insult to the pancreas that leads to the presence of acute inflammatory cells, edema, and necrosis that in some cases may result in organ damage or fibrosis. The majority of the cases are self-limited and case of acute pancreatitis, but in about 30% you could have recurrence. So, how does acute pancreatitis occur? An insult takes effect leads to zymogen activation generation of inflammatory mediators, then further inflammation and ischemia necrosis and apoptosis in the gland that in a subset could lead to sirs and multi-organ failure. Symptoms that we commonly see in acute pancreatitis are intense upper abdominal pain, nausea, and vomiting, and loss of appetite, as well as back pain, a swollen or tender abdomen, fever, and tachycardia. Now that we know what it is, let's talk about diagnosis. Acute pancreatitis by definition is when the patient has two out of the three criteria: pain that is classic epigastric in origin, lipase or amylase three times the upper limit of normal, and then imaging findings. And ultrasound still remains the first line test of choice in the context of acute pancreatitis that largely reflects its availability and lack of ionizing radiation. However, we know that ultrasound is only moderately sensitive. And so if you are suspecting acute pancreatitis, you're not able to make a diagnosis with ultrasound, and particularly if you're looking for complications. That's really where we're using CT when we need to confirm a diagnosis or when we're concerned about complications, that's when you can leverage CT or MRI. What I would like to say is that we get calls often. So the kid has acute pancreatitis, do you want an MRCP? That's really not the first imaging modality that I want to think about. Right. So now that we can identify patient with acute pancreatitis, let's talk about treatment. Remember that pancreatitis is a state of hypoxia. You need to reestablish the intravascular flow to the pancreas to prevent hypoxia, necrosis, atrophic pancreas insufficiency. So the early fluid resuscitation was associated with reduced incidence of sirs and organ failure at 72 hours. How much fluids? So we should start with 10 to 20 CCS per kilo and reassess according to the patient's age and weight. It's always better. You cannot flood this lungs too much because the outcomes are worse. It's been shown that LR decreases the incidence of the inflammatory response and C C reactive protein at 24 hours compared to NS. Now, there's no reason to give antibiotics for pancreatitis even in the face of world of necrosis or necrotizing pancreatitis. Feed the pancreas as soon as the patient is able to tolerate PO. Just give ental nutrition significantly better compared to TPN or MPO. It's just okay to tolerate some some some vomiting. Perfect. Let's summarize what we've seen today. Acute pancreatitis is the inflammation of the pancreas that occurs by activation of the insights inside the gland. This cause acute pain in the epigastric region and can lead to nausea, vomiting, fever, and tachycardia. Ultrasound is the first line of imaging modality, but we should use CT for complications or if we have diagnostic doubts. For the treatment, we have to replace fluids, and from the work that we've seen, it's better to use LR. Also, you should start feeding as soon as possible and know that antibiotics are not needed unless there's evidence of infection. So that was all for today. I hope you enjoy it and join us in the next videos about pancreatic pathologies by the Pancreas Care Center. GlobalCast MD along with Cincinnati Children's Hospital, sharing knowledge to improve child health around the globe.