NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Table 7-1: Ranson Prognostic Signs Associated with Acute Pancreatitis On admission Age older than 55 years White blood cell (WBC) count >16,000 cells/mm 3 Glucose >200 mg/dL

Lactate dehydrogenase (LDH) >350 IU/L Aspartate aminotransferase (AST) >250 IU/L After 48 hours Hematocrit decrease = 10% Blood urea nitrogen (BUN) increase = 5 mg/dL Ca 2+ level <8 mg/dL Pao 2 <60 mm Hg

Base deficit >4 mEq/L Fluid sequestration >6 L

Abscess

Q: What is the next step? A: An experienced clinician should decide which type of drainage to use because some collections contain a large amount of debris and cannot be drained with a catheter. Appropriate antibiotics, usually for gram-negative and anaerobic coverage, are nec- essary. If adequate percutaneous drainage is not possible, open surgical drainage is required. For a peripancreatic collection with internal loculation or debris, sam- pling by a percutaneous route under CT scan or ultrasound guidance is necessary, if possible. For a large number of WBCs or bacteria, the diagnosis of an abscess is appropriate, and abscess drainage is essential. Drainage may occur either surgically or percutaneously with a catheter. Figure 7-23: CT scan of a pancreatic abscess with air in the cavity. SAMPLE

While the patient is recovering from percutaneous pancreatic abscess drainage, the patient suddenly becomes hypotensive and the drainage becomes bloody.