Pancreatic topics for General Physicians
How pancreatic disorders is tested
Written for DHA, SMLE, DOH, QCHP, OMSB, MOH, NHRA and Kuwait MOH — the same GP licensing mix, not a pancreatic disorders specialist paper.
Pancreas GP items are diagnosis, fluids, gallstone ERCP timing and infected necrosis — not Whipple reconstructions.
Diagnose with pain plus lipase. Early CT is usually wrong. Gallstone pancreatitis with cholangitis needs ERCP; mild stone disease waits for cholecystectomy on the index admission when possible.
Necrosis is watched unless infected (gas on CT, failure to improve). Nutrition is enteral, not prolonged NPO “to rest the pancreas.”
Does every pancreatitis get a CT at arrival?
No. Clinical plus labs first. CT for doubt, failure to improve, or suspected complication after several days.
When is ERCP indicated?
Concomitant cholangitis or persistent biliary obstruction. Not for every raised ALT in mild pancreatitis.
Infected necrosis — first idea?
Antibiotics that penetrate necrosis and a step-up drainage approach, not immediate open necrosectomy in a stable patient.
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