study_ing
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CT
Us good for galbladder, but bowel gas usually cozes poor visualization of pancreas
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| frank100
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ct
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| MDcooper
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CT scan is more accurate than US.So CT scan is the first step.
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| som
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in the same case above substitue female for male with same symptoms and say same labs but NO h/o alcoholism and PE is nml except for an agitated women leaning forward position. also no h/o smoking or any drug intake. then what wud be the next inv?
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| study_ing
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id still go for a CT
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| MDcooper
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in females stones are the probable etiology.Still CT is superior to US according to my knowledge.
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| GDS2008
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It is all about what the question asks U.If the questions says "what would be the next step to identify the underlying pathology?" I will go for U/S. However, if the question asks "what would be the next best step to confirm/support your diagnosis?" I will go for a CT scan. Again, just a point like appendicitis, acute pancreatitis is also a clinical diagnosis based on the clinical presentation and Amylase and lipase levels. All other investigations that are done are either 1) to identify the cause (hx, US), 2) assess the severity (Ranson's criteria +/- CT) and 3) if the diagnosis is nto certain a CT scan
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| MDcooper
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I got it.To determine severity of diseaese CT shouldbe done.I am not sure about US for diagnosis and what should be the first intervention
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| som
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in the female case, the asks abt the inv to be done to detrmine the likely etiology?
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| GDS2008
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U/S should be the answer in that case
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| Sea_gull
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In case of females U/S to dertmine eitiology is logical because Gall stones are the most common cause of Acute pancreatitis in females.Am I right dear Som and GDS2008??
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| frank100
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agree with GDS2008 at #6 and sea_gull in #12.
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| study_ing
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well i remember in my clinical rotations ( as in i havnt read it recently htough) that in most cases of gallstone pancreatitis the stone has already passed..asymptomatic gallstones in a pt are also very common..hence in a pt with pancreatitis i'd focus on the pancreas and hence CT..
if in fact the stone hasnt passed, the pt wud be deteriorating rapidly and we'd have to do an ERCP for stone removal.
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| som
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right Sea_gull, usg to be performed in this female pt as the etiology of gall stone is more likely here than alcoholism. Ct used for confirmation
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| tolito
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study_ing, usually gall stones are multiple ( have not read it up recently tho cos i know that there are many kinds). so she may have passed the one that caused the problem but there are others still. if an USS is done it will reveal the pathology in the case of the woman. ie if question asks about what inv will be done to determine etiology.
i dont know that CT is superior to USS in gall bladder disease.
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| robin082006
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I go with CT too
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| GDS2008
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ok let us this question, what will change the future management? us or ct
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| study_ing
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CT..its the best way of grading the pancreatitis..
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