Pancreatitis and Gallbladder Disease
Acute and chronic pancreatitis, cholecystitis
Acute pancreatitis
- Causes: gallstones, alcohol, very high triglycerides, after ERCP, some drugs.
- Severe epigastric or LUQ pain radiating to the back, worse lying flat; better sitting up and leaning forward.
- Nausea, vomiting, fever, tachycardia.
- Cullen's sign (bruising around the navel), Grey Turner's sign (flank bruising): bleeding, severe disease.
- Labs: lipase ≥3× upper limit; high glucose; low calcium (check Chvostek's and Trousseau's signs).
Treatment Updated
- IV fluids (lactated Ringer's), moderate and goal-directed: too much fluid causes harm.
- Pain control, including opioids.
- Early oral feeding (within 24–72 h, low-fat) once pain and nausea allow. Prolonged NPO to "rest the pancreas" is outdated.
- If unable to eat: tube feeding is preferred over TPN.
- NG tube only for vomiting or ileus. No routine antibiotics.
- Gallstone pancreatitis: cholecystectomy during the same admission.
Chronic pancreatitis
- Ongoing pain, weight loss, fatty stools (steatorrhea), diabetes.
- Pancreatic enzymes with meals and snacks; insulin; stop alcohol and smoking.
- Small, low-fat meals.
Cholecystitis and gallstones
- RUQ pain after fatty meals, radiating to the right shoulder or scapula; Murphy's sign; nausea, fever.
- Blocked bile duct: jaundice, dark urine, clay-colored stools, itching.
- Ultrasound; laparoscopic cholecystectomy; ERCP for duct stones.
- After laparoscopic surgery: shoulder pain from CO₂ gas: walk, warm packs per order.
- Low-fat diet if symptoms persist.
Priority
Pancreatitis can cause shock, ARDS, low calcium (tetany, seizures), and high glucose. Watch breathing, BP, urine output, calcium and glucose closely in the first 48 hours.