Consultant Corner: Pancreatitis
Surgical consultation is useful in three specific scenarios: (1) when a surgical etiology of pancreatitis is identified, (2) when surgical complications of pancreatitis are identified, and (3) when a team approach is necessary to manage the long-term sequelae of pancreatitis. Computed tomography (CT) of the abdomen and pelvis may be the first imaging study obtained, but if the diagnosis of pancreatitis is confirmed, ultrasound imaging of the gallbladder and hepatobiliary tree will help identify the most common etiologies (e.g., gallstone pancreatitis). Gallstone pancreatitis should prompt an evaluation for cholecystectomy during the index presentation. With the most recent literature suggesting that both under- and over-resuscitations have negative implications for patients with AP, we recommend using clinical markers of shock (skin perfusion, mental status, and urine output) coupled with laboratory markers of hypoperfusion (acidosis, hemoconcentration, organ failure) to guide resuscitation.