Acute Pancreatitis

[@StrongMed]

An important update regarding fluid management in acute pancreatitis: an RCT in which 249 patients were randomized to aggressive LR (20mL/kg bolus followed by 3mL/kg/hr) vs moderate LR (10mL/kg bolus followed by 1.5mL/kg/hr). The aggressive group developed more volume overload without improvement in probability of progressing to severe pancreatitis. Full abstract as follows: Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis BACKGROUND Early aggressive hydration is widely recommended for the management of acute pancreatitis, but evidence for this practice is limited. METHODS At 18 centers, we randomly assigned patients who presented with acute pancreatitis to receive goal-directed aggressive or moderate resuscitation with lactated Ringer’s solution. Aggressive fluid resuscitation consisted of a bolus of 20 ml per kilogram of body weight, followed by 3 ml per kilogram per hour. Moderate fluid resuscitation consisted of a bolus of 10 ml per kilogram in patients with hypovolemia or no bolus in patients with normovolemia, followed by 1.5 ml per kilogram per hour in all patients in this group. Patients were assessed at 12, 24, 48, and 72 hours, and fluid resuscitation was adjusted according to the patient’s clinical status. The primary outcome was the development of moderately severe or severe pancreatitis during the hospitalization. The main safety outcome was fluid overload. The planned sample size was 744, with a first planned interim analysis after the enrollment of 248 patients. RESULTS A total of 249 patients were included in the interim analysis. The trial was halted owing to between-group differences in the safety outcomes without a significant difference in the incidence of moderately severe or severe pancreatitis (22.1% in the aggressive-resuscitation group and 17.3% in the moderate-resuscitation group; adjusted relative risk, 1.30; 95% confidence interval [CI], 0.78 to 2.18; P=0.32). Fluid overload developed in 20.5% of the patients who received aggressive resuscitation and in 6.3% of those who received moderate resuscitation (adjusted relative risk, 2.85; 95% CI, 1.36 to 5.94, P=0.004). The median duration of hospitalization was 6 days (interquartile range, 4 to 8) in the aggressive-resuscitation group and 5 days (interquartile range, 3 to 7) in the moderate-resuscitation group. CONCLUSIONS In this randomized trial involving patients with acute pancreatitis, early aggressive fluid resuscitation resulted in a higher incidence of fluid overload without improvement in clinical outcomes. www.nejm.org/doi/full/10.1056/NEJMoa2202884?query=featured_home

[@JenniferChernecki]

I'm currently dealing with acute pancreatitis. It hurts. I have no medical background but this really helped to explain the intricacies of what's going on. Thank you.

[@rekhazlifestylevlogsinkann6034]

Hi Jenni did this attack again

[@battlecat403]

How long until you recovered?

[@JenniferChernecki]

@@battlecat403 it took about 4 weeks after the first time and then an additional 6 months or so for it to totally calm down. Now I only get a little itch of pain if I drink too much or eat too much crap food.

[@saamiyakamaluddin8393]

I am a doctor.i had previous attack of acute pancreatitis.i swear it was worse than childbirth without anesthesia. I wished to die.took a week to calm down.after that I completely turned to low fat diet and no sugars.i pray that you get well soon.i pray that God helps you in this difficult time.i may be a stranger but we r connected via humanity and pain.lots of love and prayers♥️♥️♥️♥️♥️

[@Mystomach]

No red meat. No alcohol. No animal fats. Always stay hydrated pancrease loves fluids

[@rekhakadam6393]

Many thanks 🙏🏻. No need to refer to any other source of information after listening to this video. Complete coverage of the topic...!!!! Thanks for the efforts taken !!! 🙏🏻🙏🏻.

[@InaamHD]

Thank you for this! This was a great video, and I especially appreciated your sharing of the changes in the patient's CT with development of WON. I will definitely be following this series going forward.

[@magical8013]

I was a bad alcoholic, I started drinking when I was 13 and have been to multiple detoxes for alcohol. Anyways one morning I woke up and started drinking to get rid of the withdrawals from alcohol. And I noticed the pain in my stomach and I immediately threw up. I just figured it was the withdrawals, so I decided to drink more alcohol to get rid of them. That didn't work. I kept throwing up and having to hold my stomach because it hurts so bad. I ended up going to the hospital and found out I had acute pancreatitis. That was the worst pain I've ever felt for a week. I was getting pain medicines but it still wasn't helping. The doctor told me if I ever drink again I can expect to feel that pain and possibly die because alcohol is now like poison to my body try telling that to an alcoholic. Unfortunately most alcoholics who are told this do not stop drinking because of the type of hold alcohol has over them. I started to drink a little bit a month later. The difference is I started to feel the pain the next day and very weird and weak. I did this a few more times and I just could not get rid of the pain or how I was feeling. Drinking was not fun for me anymore, especially if I was in pain all the time and felt like death. So I decided to stop and I've been clean 2 years. Unfortunately once you hat pancreatitis you have to watch what you eat. I didn't even know that. I just figured I didn't have to drink alcohol. I was eating whatever I wanted, fried foods ice cream, whole milk, everything, all day long. I started to feel the pain again and now I have to watch what I eat. Stop while you can, I don't think I would have stopped drinking if it wasn't for pancreatitis though. I'm grateful, but also ashamed. I've had a lot of friends die from alcohol related causes. I didn't want to be one of them

[@339Memes]

good for you , never too late to change

[@mrcharlesjohnson]

I love this channel. This is always the 1st place I look

[@অনামিকা-ন৬ম]

Thank you so much for your concised beautiful presentation.

[@HarpreetKaur-ti2xp]

Hi doctor I had bad gallbladder infection and then got my liver enlarged and doctors had to perform an emergency surgery to save my life as I was in sepsis But after removal of gallbladder I started having mild pain in right upper abdomen part and I was very cautious of my liver which showed mild fatty infiltration But there have been 2 too worst pain episodes in my life where I had consumed milk or some fatty food I had life taking pains When I went through various scans it shows Mildly enlarged pancreas showing loss of normal pancreatic lobulations with normal signal intensity noted. No peripancreatic fat stranding/collection noted. No focal lesion seen . MPD is not dilated

[@TheDotty40]

I had severe acute pancreatitis...was put into acoma for 11 days......I have never drank alcohol...smoked or touched drugs!.....I have a horrible bowel disease.......which caused the gall bladder stones...they removed 78 stones from my gall bladder......so painful......

[@magical8013]

Yeah I think a lot of people have a misconception when it comes to pancreatitis. There's different types of causes, there's alcohol, there's medication and there's a bad diet. Three things that can cause acute pancreatitis. So you cannot drink or use any drugs but eat horrible food and get pancreatitis. Or you can eat healthy not drink and take medication that is prescribed to you and end up having pancreatitis

[@ghdsds]

Great to see you are making new videos!

[@emuronjoseph231]

great discussion, i have surely added on more knowledge on this subject

[@dsoogrim]

Another gem....i absolutely enjoy your lectures....thanks so much for sharing...stay safe

[@cornelbacauanu1544]

Much appreciated. Thank you for time and effort.

[@zasulieman]

Very organized presentation ❤❤❤

[@rbkat100]

Great content! Gave me a better understanding! Thank you!

[@4cooldoc]

Great Video as alway! Thank you Dr Strong.

[@annfrost3323]

Should note that the information provided is for medical professionals as there is no explanation for lay people of anatomical names or abbrevations.

[@dailydoseofmedicinee]

Thanks for your effort.

[@ezmed2044]

Wow, your lectures are really informative. They really encourage me to make more videos for Medical students on my channel. Keep up the good work! 😊

[@123miltos]

Very compact and informative video ! Thank you ! What I didn’t see discussed is the indication of emergency ERCP in obstructive pancreatitis due to gallstones . This matter can get really tricky . From my experience in the ER , I came across a lot of cases where the patient has a typical pancreatitis presentation but has not only Lipase but also labs that suggest cholestasis and a little bit of fever . So questions come like is it only pancreatitis or cholangitis ? Should I do the CT scan ? ( age , CrC? ) . I can’t really see the DHC in sonography how severe is the obstruction ?

[@zuhairyassin505]

i hope Dr.strong answers it would be interesting to hear his opinion

[@poojag8680]

I've learnt a lot from you Dr Strong ! Thankyou so much !

[@durganandyadav3794]

Very informative, thank you sir

[@lirannevetgolan5174]

It took me about 30 videos, but I finally figured it out. You look like Chris Parnell :) Definitely one of my favorite SNL cast members. Anyway, thank you for the explanations!

[@StrongMed]

I was a little apprehensive about Googling Parnell, since I didn't know who he was...I most often hear that I look like Alan Ruck (Cameron from Ferris Beuller's Day Off). I concur more with you though!

[@Zerob2b]

Thank you so much, Can u please do a lecture about diabetes from ur point of view? there are a lot of videos about diabetes on youtube, but i'm sure a lecture made by you would be better since u're way more meticulous than the others. Hope u'll read my comment.

[@StrongMed]

I have a video on the inpatient management of diabetes here: kzbin.info/www/bejne/qqvRZZ19erFrbas. It's 8 years old, but all of the general points still apply. I'm hoping to post a video on outpatient diabetes management in the next several months.

[@rekhakadam6393]

Strong Medicine please do an out patient approach to diabetes management with different comorbidities in young as well as the elderly. A request. Thank you 🙏🏻

[@Zerob2b]

Strong Medicine thank you so much

[@agustinbaez951]

Eric, first of all I would like to say that I appreciate all the work that you do, I wanted to suggest you, would it be possible recording like hospital blogs where you get to make reviews of the patients that are admitted? Again, thanks for everything...

[@StrongMed]

Speaking on social media about patients gets a little tricky with our hospital privacy policies. As a general rule, it's advised that a significant length of time should pass in between a patient case and when it's discussed on social media. Having said that, I had been working with a few others on a project in which old patient cases would get presented to expert clinicians who were not familiar with the case, and then who would discuss them as the case unfolded - sort of like a video version of the NEJM case records. Unfortunately, it got sidetracked by some logistical roadblocks, and then even more so by COVID, but I'm hoping to come back to it eventually. In the meantime, you might enjoy the Clinical Problem Solvers' virtual morning report series: clinicalproblemsolving.com/learn-live/

[@studentforlife9687]

Great video as always Dr Strong !

[@manoboy3883]

Thank you strong very good video , Very informative Kindly make video for cardiac arrhythmia and their management

[@tanealiawizzard6291]

Amazing video!

[@Nox.INkRecords]

Very useful Thanks for sharing.

[@ΆγιοςΧίλαριος]

Thanks Dr Strong for this great presentation! I once heard that if ALT is above one cutoff (I think 150), it strongly rules in gallestones as the inciting cause of AP but I'm wondering the accuracy of this info. Also, I want ask if blood & tissue cultures are negative yet the patient makes the criteria for septic shock, are there any evidence giving antibiotics (or using procalcitonin as an indicator) ?

[@markjohnston465]

My mother just passed away due to pancreatitis golbladder unexpectedly on the 26.11.2023 was feeling sick and pain in stomach and back took her into hospital and she was there on the Friday and then passed away on the Sunday morning at 4 in the morning seriously didn't expect her to die I thought she would pull through but nope they couldn't get the stone to flush out and they couldn't operate and then all her organs started to fail soon as they took the machine's off her she literally passed away within 1 minute to 1 min and a half. They put 7 ltrs of water through my mum and only 300 ml came out.my mum didn't drink all her life she only smoked and she was 75 year's old. Missing you loads mum hope you're having a heavenly Christmas love you very very much ❣️❣️❣️❣️❣️❣️❣️❣️ until we met again may you rest in peace

[@Tonnie31]

Great Video. Thank you!!!

[@ramzarukia120]

Dr Eric please teach us POCUS.

[@leezhengyangbrandon5080]

Cool new intro Dr. Strong

[@SajanAcharya]

Hello Dr. Strong! Thank you for all your effort. I have been making notes of some of the intern content. Do you mind me sharing the notes, for free and with references pointing to you ofcourse, on my personal blog? Thanks!

[@sunving]

Thank you Dr Strong

[@zakariyyagardee8934]

Thanks a lot for the video, Dr Strong. What are your thought's on Professor Josh Farkas feelings over @PulmCrit that analgesia with Acetaminophen and Ketamine should be used, as Opioids may increase the risk of Ileus in these patients?

[@StrongMed]

I'm not familiar with Farkas' specific take on it, but agree that opioids increase the risk of ileus in severely ill patients, including those with pancreatitis. However, I think the main limiting factor with using ketamine is often physicians' lack of familiarity. Outside of the ICU and ED, it's not that common to see it. Across the last 3 hospitals I've worked at, 100% of the time when ketamine is used on the medical or surgical floor, it's a consulting pain service who has ordered it rather than the primary team. Maybe ketamine use (and physician comfort with it) varies across geography?

[@zakariyyagardee8934]

@@StrongMed Thanks a lot Professor! Much love from an Internal Medicine loving Med Student in Cape Town :)

[@niazwali8169]

Nice sir making more video of medicine

[@khomeiniruhollah]

Thanks Eric

[@shermukhammadabdugofurov7602]

Hello. That’s such a great video. I would like to ask if there is anyone who had experienced with that disease and got cured. I have been suffering from that disease for more than two years. And went to see a lot of doctors but nothing has changed. I feel it is getting worse. I need your help. I would like to write if you know any doctor to recommend.

[@StrongMed]

I'm sorry to hear about how you've been feeling. I can't give specific, personalized medical advice here, but acute pancreatitis typically lasts < 4 weeks; it does not last multiple months, and definitely does not last 2 years. It's *possible* you have chronic pancreatitis and/or a long-standing pancreatic pseudocyst, both which can be caused by acute pancreatitis, but which they are different diseases with different treatments than the one covered in this video.

[@SKARTHIKSELVAN]

Thanks for putting efforts in making these videos.

[@mechanicman8687]

You need to quit drinking or you will be dead in 6 months... they told me 12 years ago. I quit drinking. Dying hurts too much

[@rajuthapa4816]

Did You had a acute pancreatitis? How you maintaining this disease ?. I have been this 3 weeks and I have still pain in my stomach and feeling burning in chest and stomach. Please tell me how to overcome this disease

[@mechanicman8687]

@@rajuthapa4816 Life sucks better sober

[@rajuthapa4816]

@@mechanicman8687 please tell me how we can manage

[@mechanicman8687]

@@rajuthapa4816 Quit drinking, smoking, don’t eat fried food. Talk to a doctor. I’ll pray for you. I know how bad this hurts. Quit drinking alcohol. Now more ever

[@rekhazlifestylevlogsinkann6034]

@@mechanicman8687 hi sir.. thanq soo much this messaged helped a lot.. how long did u suffer from acute pancreatitis

[@WishYouWereClear]

much love from Brazil

[@nazranuhman9222]

Wonderful!!!! Thank you

[@abdulmanafm2208]

Thank you dr strong...

[@drmahmoudalosman2277]

Thanks alot First comment ☺️☺️☺️☺️

[@BUTTA170]

After acute non necrotizing pancreatitis, is there ever a safe time to resume the use of alcohol in moderation? And if so does the type of alcohol matter? Wine/beer compared to rum whiskey. It has been over 2 years since the illness.

[@rekhazlifestylevlogsinkann6034]

Hi sir what diet did u follow pls let me know it ll be very useful now .. nd did u get the attack again or only once

[@abc-ei3ik]

Thank you so much!

[@xs2dranwarkamal]

MaShaaAllah

[@Shashankofficial24]

Thanks 😍🤩🙏🙏🙏🙏🙏🙏

[@rizz1088]

If the medical centre doesn't have CT imaging, lipase, calcium test what should we do?

[@StrongMed]

Every diagnosis of pancreatitis would need to be based on just history + exam (acute onset of abdominal pain, nausea, vomiting associated with epigastric tenderness), but unfortunately, these are not very specific. Gastroenteritis, food poisoning, peptic ulcer disease, appendicitis, biliary disease, hepatitis, and diabetic ketoacidosis can all present similarly. (In the video, where I mention that pancreatitis is not a "diagnostic mystery", that was assuming that lipase and CT are available...) The practice of medicine in extremely resource limited settings is a whole field in itself. As a med student, I did spend 6 months at a hospital without basic labs, but I really wouldn't be sufficiently qualified to offer detailed advice on this. Which country are you in?

[@rizz1088]

@@StrongMed a huge third world country with suboptimal diagnostic test somewhere in Southeastasia Yes because sometimes abdominal pain itself are not very spesific, in my 1 year internship i never found acute pancreatitis itself because limited resource. Heck even USG is hard to obtain because the price is expensive and limited operator 😭 ☺️👍

[@marykaye7784]

The name of the surgery done for acute pancreatitis is? Please help if anyone knows the answer..gm..advance thank you

[@StrongMed]

There is not just one surgery - which procedure is done depends what the specific problem is. But I suspect you are thinking of pancreatic necrosectomy .

[@zuhairyassin505]

why are physicians in russia are still administrating somatostatin as a treatment choice ? is there any evidence that it improves clinical outcomes in acute cases ?

[@StrongMed]

I can't speak about conventional medical practice in Russia, but regarding somatostatin, it's been kicked around as a potential treatment option in pancreatitis for decades (including as prophylaxis against post-ERCP pancreatitis), though I haven't seen in actually used in a patient since medical school (~2000). The bottom line regarding the pharmacologic treatment of pancreatitis is that nothing has ever been conclusively demonstrated to work: www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011384.pub2/full. Although somatostatin is relatively safe and does have a plausible mechanism of action (so one could argue "what's the harm?"), it's relatively expensive (at least in the US), which probably precludes its use in cases without established benefit.

[@zuhairyassin505]

Strong Medicine much appreciated Mr.strong thaks for sharing

[@tamannakarna6067]

Is this acute pancreatitis can be treated or get cure over it???

[@adilsheikh4956]

Thanks sir

[@msamarya7622]

I recently saw a 16 year male with pancreatitis he could not afford CT abdomen what may be cause in this young age. USG : abdomen normal No H/o alcoholism

[@StrongMed]

Pancreatitis is relatively uncommon at that age. 3 etiologies not mentioned in the video but which are more applicable to the pediatric population are congenital abnormalities of the pancreatic ducts, infections, and traumatic pancreatitis. Here's a good review article: www.ncbi.nlm.nih.gov/pmc/articles/PMC4231506/

[@msamarya7622]

@@StrongMed thanks you I really appreciate you videos. I think these are finest videos and watch them regularly. Even subscribed them. Please also suggest in every video if you are at village level and the patient doesn't have financial conditions and do not want to go & get treated at higher centre. So in total how were these patients got diagnosed and treated in older days.

[@yalldontme.......251]

Can you please do these videos using normal term's and not doctor jargon please!!!!!

[@StrongMed]

I'm sorry it was hard to follow, but this video is from a series entitled "intern crash course". These videos are specifically created for an audience of newly minted physicians.

[@One-Crazy-Cat]

It’s not too cute when you get.