Acute Pancreatitis

An overall of the etiologies, presentation, diagnosis, treatment, and complications of acute pancreatitis, including use of antibiotics and the management of peripancreatic fluid collections.

[StrongMed]

An important update regarding fluid management in acute pancreatitis: an RCT in which 249 patients were randomized to aggressive LR (20mL/kg bolus followed by 3mL/kg/hr) vs moderate LR (10mL/kg bolus followed by 1.5mL/kg/hr). The aggressive group developed more volume overload without improvement in probability of progressing to severe pancreatitis. Full abstract as follows:

Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis

BACKGROUND
Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited.

METHODS

At 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer’s solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient’s clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients.

RESULTS
A total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P=0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P=0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group.

CONCLUSIONS
In this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes.

[magical]

I was a bad alcoholic, I started drinking when I was 13 and have been to multiple detoxes for alcohol. Anyways one morning I woke up and started drinking to get rid of the withdrawals from alcohol. And I noticed the pain in my stomach and I immediately threw up. I just figured it was the withdrawals, so I decided to drink more alcohol to get rid of them. That didn't work. I kept throwing up and having to hold my stomach because it hurts so bad. I ended up going to the hospital and found out I had acute pancreatitis. That was the worst pain I've ever felt for a week. I was getting pain medicines but it still wasn't helping. The doctor told me if I ever drink again I can expect to feel that pain and possibly die because alcohol is now like poison to my body try telling that to an alcoholic. Unfortunately most alcoholics who are told this do not stop drinking because of the type of hold alcohol has over them. I started to drink a little bit a month later. The difference is I started to feel the pain the next day and very weird and weak. I did this a few more times and I just could not get rid of the pain or how I was feeling. Drinking was not fun for me anymore, especially if I was in pain all the time and felt like death. So I decided to stop and I've been clean 2 years. Unfortunately once you hat pancreatitis you have to watch what you eat. I didn't even know that. I just figured I didn't have to drink alcohol. I was eating whatever I wanted, fried foods ice cream, whole milk, everything, all day long. I started to feel the pain again and now I have to watch what I eat. Stop while you can, I don't think I would have stopped drinking if it wasn't for pancreatitis though. I'm grateful, but also ashamed. I've had a lot of friends die from alcohol related causes. I didn't want to be one of them

[rekhakadam]

Many thanks 🙏🏻. No need to refer to any other source of information after listening to this video. Complete coverage of the topic...!!!! Thanks for the efforts taken !!! 🙏🏻🙏🏻.

[JenniferChernecki]

I'm currently dealing with acute pancreatitis. It hurts. I have no medical background but this really helped to explain the intricacies of what's going on. Thank you.

[InaamHD]

Thank you for this! This was a great video, and I especially appreciated your sharing of the changes in the patient's CT with development of WON. I will definitely be following this series going forward.

[mrcharlesjohnson]

I love this channel. This is always the 1st place I look

[emuronjoseph]

great discussion, i have surely added on more knowledge on this subject

[nocoadopta]

Great to see you are making new videos!

[অনামিকা-ন৬ম]

Thank you so much for your concised beautiful presentation.

[dsoogrim]

Another gem....i absolutely enjoy your lectures....thanks so much for sharing...stay safe

[TheDotty]

I had severe acute pancreatitis...was put into acoma for 11 have never drank alcohol...smoked or touched have a horrible bowel caused the gall bladder stones...they removed 78 stones from my gall

[HarpreetKaur-tixp]

Hi doctor

I had bad gallbladder infection and then got my liver enlarged and doctors had to perform an emergency surgery to save my life as I was in sepsis
But after removal of gallbladder I started having mild pain in right upper abdomen part and I was very cautious of my liver which showed mild fatty infiltration
But there have been 2 too worst pain episodes in my life where I had consumed milk or some fatty food I had life taking pains
When I went through various scans it shows
Mildly enlarged pancreas showing loss of normal pancreatic lobulations with normal signal intensity noted. No peripancreatic fat stranding/collection noted. No focal lesion seen . MPD is not dilated

[lirannevetgolan]

It took me about 30 videos, but I finally figured it out. You look like Chris Parnell :) Definitely one of my favorite SNL cast members. Anyway, thank you for the explanations!

[rbkat]

Great content! Gave me a better understanding! Thank you!

[cooldoc]

Great Video as alway! Thank you Dr Strong.

[cornelbacauanu]

Much appreciated. Thank you for time and effort.

[ezmed]

Wow, your lectures are really informative. They really encourage me to make more videos for Medical students on my channel. Keep up the good work! 😊

[poojag]

I've learnt a lot from you Dr Strong ! Thankyou so much !

[annfrost]

Should note that the information provided is for medical professionals as there is no explanation for lay people of anatomical names or abbrevations.

[mechanicman]

You need to quit drinking or you will be dead in 6 months... they told me 12 years ago.
I quit drinking. Dying hurts too much