{"type":"rich","version":"1.0","provider_name":"Transistor","provider_url":"https://transistor.fm","author_name":"Board Pearls","title":"Chapter 25, Ep 1 of 3: Acute Pancreatitis: The First Hours","html":"","width":"100%","height":180,"duration":939,"description":"Episode one of the Acute Pancreatitis chapter follows a single mechanism from trypsin escaping its compartment to the cytokine cascade, third-spacing, and lost pancreatic perfusion. The organizing idea: every first-hours decision reaches back to that mechanism. The two-of-three rule diagnoses around the failure modes of pain, enzymes, and imaging alone; the cause is worked up on admission because the trigger reshapes management; severity stays provisional while organ failure declares; and fluids are moderate lactated Ringer's titrated to hematocrit and BUN. The trial that asked whether more fluid was better answered no and stopped early.\n \nTopics covered\n\nMechanism: trypsin activation and the calcium convergence point\nTriggers: gallstones, alcohol, triglycerides, calcium\nSystemic inflammation, third-spacing, and necrosis\nClinical presentation and lipase versus amylase\nRevised Atlanta two-of-three diagnosis\nSeverity grading by organ failure\nEtiology workup during the index admission\nSeverity scores and first-day hematocrit and BUN trends\nModerate goal-directed lactated Ringer's resuscitation\n \n \nKey decisions\n\nDiagnose acute pancreatitis on the revised Atlanta two-of-three rule: characteristic upper abdominal pain, lipase or amylase over three times the upper limit of normal, or characteristic cross-sectional imaging.\nOrder lipase rather than amylase because it rises within four to eight hours, stays up for eight to fourteen days, and is pancreas-specific, and remember the enzyme height does not track severity.\nAvoid routine early CT because necrosis takes seventy-two to ninety-six hours to demarcate; reserve imaging for diagnostic uncertainty, failure to improve at forty-eight to seventy-two hours, or suspected complications.\nGet a right-upper-quadrant ultrasound in everyone, since a positive study means same-admission cholecystectomy, and treat an ALT over three times normal (roughly above one hundred fifty) as a strong pointer to a gallstone cause.\nDefine...","thumbnail_url":"https://img.transistorcdn.com/-FuAdDBcPDLhEoUmroZKtOBRvuBn_FHPpYlh41hOnU4/rs:fill:0:0:1/w:400/h:400/q:60/mb:500000/aHR0cHM6Ly9pbWct/dXBsb2FkLXByb2R1/Y3Rpb24udHJhbnNp/c3Rvci5mbS9iNzlh/ZTU4Y2MzNWExMjQ5/MjA5OWMwMmI3ZTk5/NGFiZS5wbmc.webp","thumbnail_width":300,"thumbnail_height":300}