Thanks for your question. The imaging you chose depends on the other differential diagnosis . Options include ; Abdominal ultrasound, CT of abdomen, or MRCP.
What about chronic pancreatitis ? I’ve been told their lipase and amylase may be elevated with chronic pancreatitis. Will a CT w/contrast rule out an obstructed bilary stone ? Thanks
A CT with contrast generally assists in determining severity disease process in chronic pancreatitis and diagnosis of biliary colic. Biliary stones independent of pancreatitis though, an ultrasound is generally appropriate and less invasive. Amylase and lipase may be slightly elevated in Chronic pancreatitis but usually higher in acute pancreatitis.
Thank you, this was helpful, starting advance patho this summer. I had pancreatitis once and it was the worst pain I’ve ever experienced. I spent 5 days in the hospital.
Totally! You're welcome! Contrast ab CT is typically the imaging of choice for patients with a concern of pancreatitis, it's difficult to see the pancreas on ultrasound. MRI is also an option but I see CT more often in terms of accessibility/insurance.
Hey Liz, you are wonderful; oh how I wish rapid transport of knowledge from your brain to mine was possible :) I know you said that you have never actually witnessed pancreatitis in person. To premise this, I should mention that I am a new grad NP (still in the credentialing process, so not seeing patients yet.) However, while working in as a RN in the ED, I have seen many presentations of acute pancreatitis, these patients are in severe pain. With that in mind, while watching this all I could think was "would we keep a patient who presents with these symptoms to do a work up or send the directed to the ED?" In conclusion of your video it made more sense, because moderate cases can be treated on a outpatient bases. All that said, it got my wheels turning, and made me wonder, would you (or anyone else reading this) do a workup in the office on someone who presents with this type of severe abdominal pain or send them to the ED? I know its never black and white and variables such as turn around times on diagnostics would have to be considered. Just curious of your thoughts. Thanks for ALL YOU DO!!
You're so welcome! Such great questions. It's really case by case as you said, it depends on the severity of the pain, the vital sign stability, and your differentials. If your differentials included something that was imminently dangerous or needed diagnostic clarity ASAP with imaging, most of the time they need to get sent to the ED. So sometimes even mild to moderate cases are pancreatitis are concerning when you see them-- before you get lab results-- and so if you make that decision to order a stat CT, most of the time that's done in the ER. It's tricky clinical judgment decisions though! And I use that guidemarker if I'm trying to order one or more labs/tests stat, they need attention in the ER setting, especially if there are red flag diagnoses at play.
![Pancreatitis: Symptoms, Causes, Treatment, Pathophysiology [Nursing, USMLE]](/img/1.gif)
What was the imaging that should be used
Thanks for your question. The imaging you chose depends on the other differential diagnosis . Options include ; Abdominal ultrasound, CT of abdomen, or MRCP.
I love you for this! don’t ever stop making these videos please!!!
So glad it's helpful!
Another cause is complications from an ERCP. That’s what caused mine.
Correct! ERCP can cause acute pancreatitis.
Awesome, thank you!
You're welcome!
Thanks for your presentations, very knowledgeable.
Glad you like them! Thanks for watching!
Very helpful review thanks
Glad it was helpful!
What about chronic pancreatitis ? I’ve been told their lipase and amylase may be elevated with chronic pancreatitis. Will a CT w/contrast rule out an obstructed bilary stone ? Thanks
A CT with contrast generally assists in determining severity disease process in chronic pancreatitis and diagnosis of biliary colic. Biliary stones independent of pancreatitis though, an ultrasound is generally appropriate and less invasive. Amylase and lipase may be slightly elevated in Chronic pancreatitis but usually higher in acute pancreatitis.
Thank you, this was helpful, starting advance patho this summer. I had pancreatitis once and it was the worst pain I’ve ever experienced. I spent 5 days in the hospital.
Glad you are better!
Thank you for your quick and thorough presentation. I am enjoying learning on your channel. Please keep the videos coming.
Thank you! Will do!
super helpful, thank you!
Glad it was helpful!
Hi, Thanks for this great presentation. I did not catch your thoughts on imaging? CT vs US?
Totally! You're welcome! Contrast ab CT is typically the imaging of choice for patients with a concern of pancreatitis, it's difficult to see the pancreas on ultrasound. MRI is also an option but I see CT more often in terms of accessibility/insurance.
Hey Liz, you are wonderful; oh how I wish rapid transport of knowledge from your brain to mine was possible :) I know you said that you have never actually witnessed pancreatitis in person. To premise this, I should mention that I am a new grad NP (still in the credentialing process, so not seeing patients yet.) However, while working in as a RN in the ED, I have seen many presentations of acute pancreatitis, these patients are in severe pain. With that in mind, while watching this all I could think was "would we keep a patient who presents with these symptoms to do a work up or send the directed to the ED?" In conclusion of your video it made more sense, because moderate cases can be treated on a outpatient bases. All that said, it got my wheels turning, and made me wonder, would you (or anyone else reading this) do a workup in the office on someone who presents with this type of severe abdominal pain or send them to the ED? I know its never black and white and variables such as turn around times on diagnostics would have to be considered. Just curious of your thoughts. Thanks for ALL YOU DO!!
You're so welcome! Such great questions. It's really case by case as you said, it depends on the severity of the pain, the vital sign stability, and your differentials. If your differentials included something that was imminently dangerous or needed diagnostic clarity ASAP with imaging, most of the time they need to get sent to the ED. So sometimes even mild to moderate cases are pancreatitis are concerning when you see them-- before you get lab results-- and so if you make that decision to order a stat CT, most of the time that's done in the ER. It's tricky clinical judgment decisions though! And I use that guidemarker if I'm trying to order one or more labs/tests stat, they need attention in the ER setting, especially if there are red flag diagnoses at play.
Excellent!