indidoc1
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6.
A 29-year-old alcoholic man is admitted to the hospital with severe epigastric pain radiating straight through to the back. At the time of admission he has a serum amylase of 1,200 U/L, a hematocrit of 39%, a leukocyte count of 18,000/mm3, a serum glucose level of 220 mg/dL, and a serum calcium level of 7.2 mg/dL. He is placed on nasogastric suction and intravenous fluids, and given intravenous calcium gluconate. By the next morning his hematocrit has decreased to 31% and his serum calcium is 6.1 mg/dL. Management with which of the following could improve his ultimate prognosis?
A. Antacids
B. Antibiotics
C. Anticholinergics
D. Daily CT scans
E. Surgical resection
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| smalley
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will go for e surgical resection..chronic pancreatitis complicated by dm
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| darkhorse
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imipenem...Antibiotics..B
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| neuroblastoma
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E
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| cool doctor
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B
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| me007
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D. Daily CTs.
More than 3 Ranson's criteria in this pt. Bad prognosis.
Multiple pancreatic absesses --> common final pathway. To anticipate and drain them as soon as they appear, daily CTs are recommended
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| Vietnamese
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D- CT scan is more managable than Ranson criteria.
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| indidoc1
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The correct answer is D. The clinical and laboratory picture described is that of severe hemorrhagic pancreatitis, with poor prognosis. Actually all of the other items (choices A, B, C, and E) remain controversial or unproven. The only option given that has become part of the standard of care for severe hemorrhagic pancreatitis is the addition of a daily CT scan. Many patients who go on to die from acute hemorrhagic pancreatitis do so because they develop pancreatic infection, which can be diagnosed with a CT-guided needle aspiration. .
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