wat would u do - okt3

[ArchivalUser]

A 56-year-old man is admitted to the hospital because of a 1-day history of acute, severe, cramping abdominal pain that radiated to his back. The pain was constant and exacerbated when he tried to eat some food. The patient attempted to self medicate with acetaminophen, but with no relief. The pain has slowly worsened and he has not had anything to eat or drink in over a day. On admission to the hospital, his serum amylase and lipase levels are elevated. The appropriate therapy is initiated and the patient has improvement in his pain. He is also started on a morphine patient-controlled anesthetic (PCA) with excellent results. Over the next 24 hours, he remains stable. A follow-up set of blood chemistries shows a BUN of 26 mg/dL and a creatinine of 1.0 mg/dL with an unchanged amylase and lipase. A right upper quadrant ultrasound shows gallstones with no ductal dilation. The patient's other medications, besides the PCA, are diazepam for sleep and diphenhydramine.

The most appropriate next step is to
A. arrange for endoscopic retrograde cholangiopancreatography
B. arrange for hepatobiliary iminodiacetic acid scan
C. arrange for laparoscopic cholecystectomy
D. arrange for an open cholecystectomy
E. continue intravenous hydration and nil per os status

[ArchivalUser]

A.

[ArchivalUser]

F. Let him die!!!

[ArchivalUser]

bededoktorem, I didn't see your post, post same time

[ArchivalUser]

eee?

[ArchivalUser]

ans pls okt3...?

[ArchivalUser]

Who agree or disagree???

[ArchivalUser]

E........rx the acute gallstone pancreatiitis.........bowel rest most important as wud prevent further damage by limiting pancreatic enzyme release due to exocrine pancreas stimulation at the same time fluids important as lots of 3rd spacing in acute pancreas

lap chole wud be done electively in this patient

does not need ercp as no impacted CBD stone

[ArchivalUser]

The correct answer is E. The correct therapy for pancreatitis is hydration, avoiding oral intake, and pain control. Given the success of this therapy for this patient over the previous 24 hours, it should continue.

Some centers will arrange for an ERCP (choice A) within 2 days of a pancreatitis episode to determine if papillotomy may be beneficial in abrogating the course of the disease. There is some clinical data for this but it is not yet common practice.

A HIDA scan (choice B) is used to diagnose cholecystitis, it is not indicated given that the abdominal ultrasound did not show evidence of this entity (gallbladder wall thickening, sludge).

Arranging for a laparoscopic cholecystectomy (choice C) or open cholecystectomy (choice D) will eventually be necessary given the pancreatitis and the presence of gallstones. However, this is not to be done presently and is generally done after the pancreatitis episode has passed (6-8 weeks).

[ArchivalUser]

thanks okt3