Question about pancreatitis

Wanted your opinions on your management. If you have someone come in with mild pancreatitis unknown etiology (full work up normal) with no abnormal labs other than the lipase being>5000. Vitals stable. APACHE II on admission 3. And patient wants to eat the next day with pain improved despite lipase being still>5000. Would you initiate early refeeding or would you wait a while?
Source: Student Doctor Network - Category: Universities & Medical Training Authors: Tags: Internal Medicine and IM Subspecialties Source Type: forums

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CONCLUSIONS: Moderate certainty evidence suggests that AZA and 6-MP may be superior to placebo for maintenance of surgically-induced remission in participants with CD. There was no clear difference in the number of clinical relapses when purine analogues were compared with 5-ASA agents, however this is based on low certainty evidence. There was very low certainty evidence that AZA and 6-MP are more likely to result in more serious adverse events (SAEs) and withdrawals due to an AE (low certainty) when compared to 5-ASA agents. Very low certainty evidence suggests that purine analogues may be inferior to anti-TNF-α ag...
Source: Cochrane Database of Systematic Reviews - Category: General Medicine Authors: Tags: Cochrane Database Syst Rev Source Type: research
ConclusionColonic stenting is useful as a bridge to surgery in the management of large bowel obstruction.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
Conclusion: Available systems and scores do not reflect recent advances and guidelines in CP and are not commonly used. A practical clinical classification and scoring system, validated prospectively for prognostication would be useful for the meaningful analysis in observational and interventional studies in CP.Dig Surg
Source: Digestive Surgery - Category: Surgery Source Type: research
Conclusions: The nomogram achieved an individualized prediction of pancreatic stones development in CP. It may help the management of pancreatic stones.Digestion
Source: Digestion - Category: Gastroenterology Source Type: research
Conclusions: Steroid therapy is an effective choice for cysts developing in AIP to promote the release of pancreatic juice stasis. Larger lesions with multilocular morphology should be monitored closely for cyst-related complications and be considered strong candidates for steroid therapy. PMID: 31164010 [PubMed - as supplied by publisher]
Source: Scandinavian Journal of Gastroenterology - Category: Gastroenterology Tags: Scand J Gastroenterol Source Type: research
ConclusionsAssociation of splanchnic and renal vein thrombosis without inferior vena cava thrombosis as a complication of acute pancreatitis has never been reported before. There are no specific aspects of management of this complication; therapeutic anticoagulation and symptomatic treatment are the main measures used owing to the lack of available organs for liver transplant. The prognosis depends on the consequences of splanchnic thrombosis and their complications.
Source: Journal of Medical Case Reports - Category: General Medicine Source Type: research
Opioid use disorder (OUD) has become a public health crisis in the United States. OUD has been shown to have worse outcomes in patients with chronic conditions. Although opioids are widely used for pain management in acute conditions such as acute pancreatitis (AP), the impact of OUD on outcomes in patients with AP remains unknown. We aimed to evaluate the prevalence, trends and impact of OUD on outcomes in hospitalized patients with AP.
Source: Gastrointestinal Endoscopy - Category: Gastroenterology Authors: Tags: Saturday abstract Source Type: research
ConclusionLateral pancreaticojejunostomy is an effective surgical management for CP with a dilated ductal system. Its laparoscopic adoption is the rational next surgical step. It allows effective duct decompression with low mortality and morbidity. The procedure demands an advanced surgical skill set with an emphasis on intra-corporeal suturing. Those patients suffering from tropical CP with wide ductal dilatation greater than 12  mm are suited to an endostapled anastomosis which helps significantly reduce operative time without any corrosion of outcomes.
Source: Surgical Endoscopy - Category: Surgery Source Type: research
ConclusionA  tailored approach to CP patients is mandatory in this heterogeneous disease. Surgery provides good outcomes especially as prophylaxis for and treatment of chronic pain. A multidisciplinary approach is mandatory, including physicians, pancreatic surgeons, endoscopists, dieticians and radiologists.
Source: European Surgery - Category: Surgery Source Type: research
Publication date: Available online 3 May 2019Source: Surgery (Oxford)Author(s): Ravi (Rajan) RavindranAbstractChronic pancreatitis (CP) is a progressive, disabling, fibro-inflammatory disease of the pancreas of variable clinical course and is usually associated with permanent loss of exocrine and endocrine function over a period of time. The incidence is increasing. There are various aetiological risk factors that cause CP, chronic alcoholism being the most common risk factor. The TIGAR-O classification identifies all the risk factors and aetiology. Most susceptible patients have a sentinel acute pancreatitis event which i...
Source: Surgery (Oxford) - Category: Surgery Source Type: research
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