Ultrasound and CT can be used to confirm diagnosis
NPO status (for surgery), fluid resuscitation, analgesia, antiemetics, and antibiotics (ex. ceftriaxone)
Consult surgery for definitive management (appendectomy)
All patients with confirmed appendicitis will need to be admitted. Consult general surgery early.
Appendicitis is a clinical diagnosis if the patient has a convincing history and physical exam. Do not delay consulting surgery for confirmatory imaging.
There is growing evidence that antibiotics alone may be sufficient for uncomplicated appendicitis, but approximately 27% of these patients will ultimately have to undergo appendectomy within a year anyway.
Presence of at least 2 of the following: abdominal pain, lipase 3x the upper limit of normal, and characteristic findings on US or CT
Supportive care (IV fluids, analgesia, and nutritional support). Antibiotics required only if there is a clear source of infection.
Consult for ERCP/cholecystectomy if related to gallstones
Chronic pancreatitis or mild acute cases w/o evidence of biliary disease can be discharged with follow-up in 24-48 hours
Admission is required for patients with severe symptoms or unable to tolerate PO fluids.
Consult general surgery for ruptured pseudocyst or evidence of concomitant biliary disease
Gallstones and alcohol are the most common causes of pancreatitis, but can also be caused by hyperlipidemia, scorpion venom, medications, and hypercalcemia.
The Bedside Index of Severity in Acute Pancreatitis (BISAP) score can be used to help risk stratify these patients. It is more sensitive and specific than the traditional scoring systems (Ranson criteria, APACHE II)