We have previously discussed our physical exam and diagnostic approach to Ascites here.
The mainstays of treating pancreatitis includes identifying an underlying cause and correcting it (eg. gallstone, hypertriglyceridemia, hypercalcemia, etc.), pain control and fluid resuscitation. Other issues that should be considered are feeding status and preventing infection.
1. Infection: patients are prone to infection by translocation of gut organisms if pancreatic necrosis is present. There is debate in the literature whether prophylactic antibiotics are indicated, and this uncertainty is reflected in guidelines from gastroenterology societies - one recommends it, one does not. Take a look at this Cochrane review and decide for yourself: http://www.cochrane.org/reviews/en/ab002941.html
2. Feeding: The classic teaching was that we do not feed our patients with acute pancreatitis. Newer evidence suggests that early oral feeding is alright if the patient can tolerate it. Here is a good meta analysis from the BMJ.
Interesting case of ruptured psuedocyst with pancreatic fistula causing exudative pancreatitus. The most dramatic case of massive chylous acites I have seen was post acute-on-chronic alcoholic pancreatitis.
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