70year old female brought to emergency with c/o severe abdominal pain with vomitings 2days back after starting of Treatment with Ceftriaxone 2gm, Amikacin 1000mg, Metrogyl and Fluid therapy Patient start improving.. pain decreased no nausea and vomiting but last night she has developed High fever 103F Revised Inj Piperacef T 4.5gm TDS inj oflox TDS inj Metrogyl TDS Inj Amikacin 1000 OD Today's Report of CT abdomen attached please suggest prognosis, treatment

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Ac Pancreatitis. Fluid replacement is most important because a lot of fluid is collected in the third space. Few liters of fluid as bolus, then 250- 500ml / hour, monitoring the CVP, CWP + Pain management by inj Tramadol / Pentazosine / Morphine etc + inj Reglan / Ondansetron + Antibiotics ie Imipenem + Cilastatin + Parentaral nutrition, and start enteral nutrition through nasojejunal tube with low fat diet as early as possible within 48 hours. Treat Hyperglycaemia and associated hypocalcemia if present. Cholecystectomy if there is associated associated GB Stone / microlithiasis / sludge. ERCP and stenting of the pancreatic duct if there is injury and likage, percutaneous drainage of Pancreatic cyst / abscess etc

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Acute Pancreatitis with B/L pleural effusion. NPO; IV Fluid, Inj. Pantoprazole, Inj. Tramadol, Injectable Antibiotics, Ryle's tube, antipyretic inj., Inj. Ondansetron SOS.

PANCREATITIS IS THERE AND ITS ACUTE. FEVER IS DUE TO INFLAMMATION. COULD BE DUETO INFECTION. RX IS ALAREADY POSTED BY VARIOUS DR. SOS NIV AND VENTI SUPPORT . FLUID THERAPY IS PRIME IMPORTANCE AS THERE IS 3D SPACE LOSS OF FLUID . CAUSE OF PANCREATITIS MUST BE SEARCHED AS 2 MC CAUSE ARE ALCOHOL AND GB STONE . AS THERE IS AGE ON HIGHER SIDE, SO ECHO , IVC MUST BE DONE TO GUIDE FLUID THERAPY AS FLUID THERAPY IS PRIME IMPORTANCE

It is a case of acute pancreatitis and it just requires i.v fluids and analgesics. No need of such high end antibiotics especially in first week of pancreatitis. Even CT is required by the third week to rule out complications. Best antibiotics to use in pancreatitis are fluoroquinolones and carbapenems. Get rfts done. Keep n.p.o. get central line inserted. I.v fluids according to c.v.p and urine output. Maintain vitals. Supportive treatment.

Patient is having high grade fever with shivering..
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Acute Pancreatitis with Bilteral pleural effusion. Consrtvative Management .with I V fluids, antibiotics injury. Tramdol.

It is a case of acute pancreatitis with pleural effusion. Do serum amylase , lipase. Conservative line of management. Nil oral Rules tube aspiration Abdomen girth monitoring IV fluids Inj. Pan I.v Inj . Tremadol i.m Antibiotics for fever. Vitals monitoring. Follow up with amylase, lipase levels

How about putting a drain orally and keeping the stomach a rest add inj octreotide 100 mcg 6 hourly There's been lot of controversy regarding antibiotics but Upton the treating physician Keep the patient orally nil till the patient passes flatus or stool then start with liquid diet add pancreatic enzymes like Creon 40000 twice daily and get an mrcp done once the patient is stabilised

No role of NBM, R Tube drainage, Start low fat oral feed as early as patient will tolerate orally, in Acute Pancreatitis no role of Creon.
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Pancreatitis is a condition where both exocrine and endocrine functions is affected and more so with the exocrine function It'd would be quite unreasonable to say pancreatic enzymes are not required or has no role but it's your call as far as your patients are concerned

Byron Is pancreatic enzyme formulation I'm sure the patient will require when is stable

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