Jonny and Ed
Together in Surgery
Video Duration: 28 minutes
Common on surgical take (1% surgical admissions). 10% mortality
Insult leads to release of pancreated enzymes which causes 'internal autodigestion'
EtOH abuse, gallstones, idiopathic (20%)
Unwell patient +/- signs of shock. Epigastric tenderness. Absent bowel sounds (ileus), ecchymoses (Grey Turners, Cullens)
Generally unwell with vomiting and severe upper abdominal pain radiating to back (classically relieved by sitting forwards)
Urine dipstick (everyone gets one)
FBC (elevated WCC), U&Es (dehydration and renal failure), LFT (elevated ALT and AST), reduced calcium, elevated glucose, CRP
Ultrasound (? gallstones), Contrast CT
Support with analgesia and IV fluids (keep up urine output), NBM. NGT if vomiting
Antibiotics only if infection. ERCP if dilated pancreatic ducts.
Rare. usually done for infected necrosis or pseudocyst.