Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with severe, persistent epigastric pain radiating to the back, associated with nausea and non-bilious vomiting. Symptoms consistent with necrotizing pancreatitis; CT imaging confirms >30% pancreatic necrosis without evidence of infection (sterile). No fever, rigors, or hemodynamic instability noted at this time.
Clinical Examination Findings
Patient appears acutely ill and distressed. Abdominal exam reveals significant epigastric tenderness with guarding, absent bowel sounds, and mild distension. No signs of Cullenโs or Grey-Turnerโs sign. Hemodynamically stable, though tachycardia may be present. Skin turgor decreased, suggesting dehydration.
Treatment Protocol
Aggressive fluid resuscitation with isotonic crystalloids. Strict NPO status with bowel rest. Pain management via IV opioids. Serial monitoring of inflammatory markers (CRP/Procalcitonin) and renal function. Prophylactic antibiotics are NOT indicated for sterile necrosis. Nutritional support via enteral feeding if oral intake remains contraindicated >48-72 hours.