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The first 25 slides, exactly as they appear. The full deck has 77 content slides.
General Surgery
Perspective on Management of Patients with Severe Acute Pancreatitis
Built from Maingot's Abdominal Operations
What’s inside
7 sections · 77 slides
Overview
- What this topic covers
- Terms used in severe acute pancreatitis
Presentation and initial assessment
Who arrives, when they arrive, and what state they are in
- The pancreas and its duct system
- Referral to a high-volume tertiary centre
- Consequences of delayed referral
- Condition of patients on arrival
- Overview of management after transfer
The first 24 to 48 hours
Resuscitate, image properly, and find out whether it is infected
- Admission to intensive care
- Review of outside records and specialist consults
- Repeat imaging on arrival
- What the scan is looking for
- The pancreatic protocol CT
- Why the timing of contrast matters
- Recognising necrosis on CT
- Signs of infection on CT
- Peripancreatic exudate on contrast CT
- Capillary leak and the depleted circulation
- Choice of imaging by kidney function
- Protecting the kidney during contrast CT
- Limits of gadolinium in renal failure
- What a non-contrast scan cannot show
- Why prophylactic antibiotics are avoided
- Antibiotic decisions on transfer
- Indications for antifungal treatment
- Indications for fine-needle aspiration
- Avoiding a drain at the time of aspiration
- Handling of the aspirated fluid
- Action on the aspiration result
- Timing of the first percutaneous drain
- Image-guided placement of a percutaneous drain
- Roles of the percutaneous drain
- Upsizing inadequate drains
- Discussion with the patient and family
Definitive drainage: who and when
Which patients need an operation, and at what point
- Need for definitive surgical drainage
- Timing of the operation
- Indications for earlier surgery
- The late group with sterile walled-off necrosis
- Symptoms in the late group
- Walled-off fluid collection on axial CT
- Large upper-abdominal collection on coronal CT
- Clear fluid versus fluid containing debris
- Preference for open debridement in sterile necrosis
How the operation is done
Access, debridement, drains and the gallbladder
- The two principles of every drainage operation
- Choice between open and laparoscopic access
- Choice of incision
- Closure of the abdominal wall
- Entering the lesser sac
- Finding a safe entry through the mesocolon
- Debridement of necrotic tissue
- Bleeding as a guide to viability
- Choice of suture material
- The three lumens of the Axiom drain
- Placement of the operative drains
- The laparoscopic route
- Gallbladder, bile ducts and pancreas
- Cholecystectomy at the initial operation
- <10%
- Interpretation of the outcome figures
Postoperative management
Washing the cavity, feeding the patient, removing the drains
- Return to intensive care after surgery
- Continuous drain irrigation
- Criteria for reducing the irrigation rate
- Weaning the drains
- Timing of drain exchange
- Keeping drains patent after irrigation stops
- Early enteral feeding
- Nutritional depletion and parenteral support
- Choice of feeding tube
- Risks of surgically placed feeding tubes
Follow-up and the long recovery
Removing drains, handling a fistula, and what to tell the patient
- Outpatient follow-up schedule
- Withdrawing the drains
- Management of a pancreatic fistula
- The overall course of the illness
- Prognosis and the message for families
- Take-home points
- Take-home points on surgery and recovery
- References
- Maingot's Abdominal Operations, 12th Edition