Imaging for acute pancreatitis
First time presentation, abdominal pain, and increased amylase and lipase with high clinical certainty of diagnosis;
LESS THAN 48–72 hours after onset of symptoms; clinical score irrelevant;
Suspected cause
unknown cause => US abdomen to assess for gall stones
Everything else, probably => CT abdomen with contrast, see below.
Critically ill, systemic inflammatory response syndrome (SIRS), severe clinical scores (eg, acute physiology and chronic health evaluation [APACHE], bedside index of severity in acute pancreatitis score (BISAPS), and/or Marshall); GREATER THAN 48–72 hours after onset of symptoms. => CT abdomen with contrast
Continued SIRS, severe clinical scores, leukocytosis, and fever; >7–21 days after onset of symptoms. => CT abdomen with contrast
Initial presentation with atypical signs and symptoms, including equivocal amylase and lipase values (possibly confounded by AKI or chronic kidney disease) and when diagnoses other than pancreatitis may be possible (bowel perforation, bowel ischemia, etc). => CT abdomen with contrast
Known necrotizing pancreatic and peripancreatic pancreatitis, significant deterioration in clinical status, including abrupt decrease in hemoglobin/hematocrit, hypotension, tachycardia, tachypnea, abrupt change in fever curve, or increase in white blood cells; time
after symptom onset irrelevant. => CT abdomen with contrast
after symptom onset irrelevant. => CT abdomen with contrast
Educational purposes for licensed providers.
Note to Patients:
Radiology is a very large and ever changing field and this post is to help your provider. When combined with a thorough history and physical exam, this information can be very useful. Your provider is best suited to answer specific questions regarding this post.
A provider is usually a Nurse Practitioner, Physician Assistant or Medical Doctor.
Of course, this is not a substitute for medical care.
#orderwhat #pancreatitis @AFPjournal @PCareProgress @AANP_NEWS @AAPAorg #choosingwisely
