Clinical Challenges in Emergency General Surgery: Complicated Pancreatitis

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 14 December 2023

⏱️ 40 minutes

🔗️ Recording | iTunes | RSS

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Summary

Join our Emergency General Surgery team as we talk about a popular and controversial issue in surgery: dealing with complicated cases in pancreatitis. We discuss two hard-hitting cases and cover principles of diagnosis, early management and disposition, and things to look out for every step of the way.

We cover some common and some rare but particularly problematic complications. Although there is no right answer to every case of pancreatitis, we try to help learners to develop an approach to pancreatitis that considers the morbidity and benefits of every option.

Hosts: Drs. Ashlie Nadler, Jordan Nantais and Graham Skelhorne-Gross

Learning Objectives:
- Review the diagnostic criteria for acute pancreatitis
- Learn to anticipate common and major complications of acute pancreatitis
- Develop an approach to complications of pancreatitis accounting for patient, family, practitioner, and institutional factors
- Understand the risks and benefits of various methods for dealing with pancreatic necrosis and infection

TENSION trial
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32404-2/fulltext
MISER trial
https://pubmed.ncbi.nlm.nih.gov/30452918/

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Transcript

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0:00.0	Behind the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Hello everyone and welcome to the next episode in our series on emergency
0:26.4	general surgery. Today we're going to focus on one of the most challenging
0:29.9	diseases in all of emergency general surgery, pancreatitis. But before we get into that, it's my
0:35.8	pleasure to welcome back Dr. Marika Sevingi, who has agreed to join our team full time.
0:40.8	Welcome, Marika. Thank you, Ashley. Hello everybody. We are so
0:45.7	happy to have you on the team and permanently, of course, and I'm joined once again
0:50.3	by Jordan and Graham. Hi everyone.
0:54.0	Hey Ashley, hey everybody, glad to be here, glad to be talking about pancreatitis,
0:58.0	a disease that we're all pretty familiar with.
1:00.0	The reported incidents of pancreatitis is around 50 out of every 100,000 people annually.
1:05.0	But I got to say in my practice it sure seems like a heck of a lot higher.
1:08.0	For sure. I'm not sure if that's because patients with pancreatitis can get so sick or if it's the fact that the
1:14.1	complications lead to such long hospitalizations. But we sure do spend a lot of time
1:19.2	talking about and treating patients with pancreatitis. Yes we do. I think pancreatitis is an
1:24.6	interesting disease because we're all pretty comfortable making the diagnosis.
1:28.2	As a review you need two of three things. A good
1:35.0	at the elevation, life phase or amelase greater than three times the upper limit of normal and suggestive imaging.
1:37.0	I think we're also pretty good at the early management,
1:40.0	including fluids, multimodal analgesia,
1:42.0	and early interic feeding. But beyond that, there's things that can get a bit tricky.
1:47.0	I'm so glad you said that, Ashley, because I find the next phase of management really, really hard.
	...

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