Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with acute-onset, severe epigastric pain radiating to the back, associated with nausea and repeated episodes of bilious emesis. History significant for [gallstones/alcohol use/hypertriglyceridemia]. Imaging confirms acute pancreatitis with evidence of peripancreatic fluid collection (APFC) without evidence of necrosis or encapsulation. No current signs of systemic inflammatory response syndrome (SIRS) or organ failure.
Clinical Examination Findings
General: Patient appears distressed, diaphoretic, and in moderate to severe pain. Vitals: T [temp], HR [rate], BP [pressure], SpO2 [sat]. Abdomen: Epigastric tenderness on deep palpation, guarding present, hypoactive bowel sounds. No rebound tenderness or rigidity. Skin: No jaundice or Cullen’s/Grey Turner’s signs. Cardiovascular: Tachycardic, regular rhythm, no murmurs. Respiratory: Clear to auscultation bilaterally, no crackles or wheezes.
Treatment Protocol
1. NPO status with aggressive intravenous fluid resuscitation (Lactated Ringer’s). 2. Analgesia: IV opioids (e.g., Fentanyl or Morphine) for pain control. 3. Antiemetics: Ondansetron 4mg IV q8h prn. 4. Serial monitoring of electrolytes, lipase, and CBC. 5. Monitor APFC size and characteristics via follow-up ultrasound or CT scan. 6. Early enteral nutrition as tolerated. 7. Prophylactic antibiotics NOT indicated unless infection suspected.