A. Standard inpatient procedure of clinical pathway for mild acute pancreatitis
(A) Applicable objects.
The first diagnosis of mild acute pancreatitis (ICD-10: K85, 001/K85, 101201/K85, 301/K85, 801/K85, 802/K85, 901)
(II) Diagnostic basis
According to the Clinical Diagnosis and Treatment Guide-Digestive System Diseases Sub-volume (edited by Chinese Medical Association, People’s Health Publishing House), Practical Internal Medicine (12th edition) (edited by Fudan University School of Medicine, People’s Health Publishing House), Clinical Gastroenterology (Tianjin Science and Technology Publishing House)
1, clinical manifestations: acute, persistent abdominal pain (occasionally without abdominal pain).
2, laboratory tests: increased serum amylase activity ≥ 3 times the upper limit of normal value.
3, auxiliary tests: imaging suggests morphological changes in the pancreas with or without.
(C) The choice of treatment plan.
According to the Clinical Diagnosis and Treatment Guide-Digestive System Diseases Subvolume (edited by Chinese Medical Association, People’s Health Publishing House), Practical Internal Medicine (12th edition) (edited by Fudan University School of Medicine, People’s Health Publishing House), Clinical Gastroenterology (Tianjin Science and Technology Publishing House)
1. Internal medicine treatment.
(1) Supervision, fasting, gastrointestinal decompression;
(2) Maintenance of water-electrolyte balance, nutritional support therapy;
(3) drug treatment: acid suppression therapy, drugs to inhibit pancreatic secretion, pancreatic enzyme inhibitors; antibacterial drugs are not recommended for patients without signs of infection; sedative and analgesic drugs are used cautiously when necessary.
2. Endoscopic treatment: For biliary pancreatitis, endoscopic treatment can be used in medical institutions with conditions.
(iv) The standard hospitalization days are 7-10 days.
(V) Entry pathway criteria.
1, the first diagnosis must be in accordance with ICD-10: K85, 001/K85, 101/K85, 201/K85, 301/K85, 801/K85, 802/K85, 901 mild acute pancreatitis disease codes.
2, exclude acute severe pancreatitis and patients with serious complications (combined with functional impairment of heart, lung, kidney and other organs, combined with pancreatic abscess, pancreatic cyst, etc.).
3.Exclude other acute abdominal diseases: acute intestinal obstruction, peptic ulcer perforation, cholelithiasis and acute cholecystitis, mesenteric vascular embolism, angina pectoris or myocardial infarction.
4. When patients have other disease diagnoses at the same time, but do not require special treatment during hospitalization nor affect the implementation of the clinical pathway process for the first diagnosis, they can enter the pathway.
(F) Examination items during hospitalization.
1. Required examination items.
(1) Routine blood, routine urine, routine stool + occult blood;
(2) Liver and kidney function, triglycerides, electrolytes, blood glucose, blood amylase, lipase, C-reactive protein (CRP), coagulation function;
(3) Blood gas analysis;
(4) electrocardiogram, abdominal ultrasound, abdominal and chest X-rays.
2.According to the patient’s condition, the following examination items can be selected.
(1)Blood group and RH factor, tumor marker screening (CA19-9, AFP, CEA), autoimmune marker determination (ANA, ENA, IgG);
(2) abdominal CT, magnetic resonance cholangiopancreatography (MRCP), endoscopic retrograde cholangiopancreatography (ERCP), ultrasound endoscopy (EUS).
(vii) Selection of medications.
1, acid-suppressing drugs (proton pump inhibitors, H2 receptor antagonists).
2, growth inhibitors and their analogues.
3.Antimicrobial drugs: Follow the “Guidelines for Clinical Application of Antimicrobial Drugs” (Health Medical Development [2004] No. 285), and decide the selection and timing of antimicrobial drugs in conjunction with the patient’s condition.
(H) Discharge criteria.
1. Abdominal pain and bloating are relieved and feeding is started.
2. Stable decrease of blood amylase, or no significant increase after eating.
(ix) Variation and cause analysis.
1, The patient changed from mild acute pancreatitis to severe acute pancreatitis and withdrew from this pathway.
2, endoscopic treatment: for suspected or confirmed acute biliary pancreatitis that worsens during treatment, bile duct drainage or endoscopic sphincterotomy is feasible and transferred to the appropriate pathway.
3. Persistently high levels of blood amylase, or significantly elevated after feeding, and persistently high levels of CRP, leading to prolonged hospitalization.