วันพฤหัสบดีที่ 8 เมษายน พ.ศ. 2553

469. Pancreatic fluid collection/suspect

ชาย 35 ปี เป็น acute pancreatitis มา 10 วัน แต่กลับมามีไข้สูงและปวดท้องได้ 2 วัน, Abd: generalize mild tenderness, no guarding, U/S เป็นดังนี้ คิดถึงอะไร รักษาอย่างไร
ขยายบริเวณที่เป็น  anechoic area
สงสัย pancreatic fluid collection
Pancreatic-Fluid Collections, Pseudocysts, and Necrosis

Up to 57 percent of patients who are hospitalized with acute pancreatitis will have fluid collections, with 39 percent having two areas involved and 33 percent having three or more. Fluid collections are initially ill defined, evolve over time, and are usually managed conservatively. If the fluid collections continue to enlarge, cause pain, become infected (as suggested by the presence of unexplained fever, leukocytosis, or gas in the fluid collection), or compress adjacent organs, then medical, endoscopic, or surgical intervention may be needed. Fluid collections with very high levels of pancreatic enzymes are usually associated with pancreatic-duct disruptions and may eventually form pseudocysts (usually over a period of several weeks), ascites, or pleural effusions. Asymptomatic pseudocysts can be managed conservatively, whereas symptomatic pseudocysts can often be drained endoscopically. ERCP may help to define the anatomy of the pancreatic duct and identify any duct disruptions to guide further intervention.
http://content.nejm.org/cgi/content/full/354/20/2142

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