pancreatic ascites

Etiology: 1) pancreatic pseudocyst leakage (most common) 2) pancreatic duct rupture Clinical manifestations: 1) abdominal pain may be present 2) may present surreptitiously after an episode of mild pain 3) pleural effusion may occur Laboratory: 1) ascitic fluid analysis a) amylase b) WBC count, RBC count, protein, cytology c) culture for acid-fast bacteria 2) endoscopic retrograde cholangiopancreatography (ERCP) Radiology: - computed tomography with special cuts of pancreas Management: 1) nothing by mouth 2) parenteral nutrition for 2-3 weeks 3) octreotide 100-200 ug IV TID to inhibit pancreatic secretion 4) failure to respond to 2-3 weeks of conservative management a) ERCP b) endoscopic placement of a stent across area of leak c) surgical resection proximal to disrupted duct

References

Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998