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Have Acute Pancreatitis, Lungs And Liver Infected, Waiting For Gall Bladder Removal. What Are The Chances Of Survival?

Posted on Mon, 13 Aug 2012

Question: My friend is seriously ill with acute pancreatis caused by a gall stone getting into the pancreas. The pancreas has become necrotic and that portion needs to be removed. Her lungs and liver are also infected. She is in the High Dependency Unit of our local hospital. She is waiting to be transferred to Dublin where her gall bladder and the dead parts of her pancreas need to be removed. I need to know what are her chances of surviving this? I was with her today and she is still fully conscious despite high temperature and being on oxygen. We've been friends since we were children but because I'm not family, I haven't been able to talk to docs at the hospital. I'd really appreciate direct and honest information. She is also about 4 stone overweight. Thank you.

Answered by Dr. Rakesh Madhyastha (3 hours later)

Hello

Thanks for the query

I will like to know a few more details in order to come to a better conclusion

1. Is she a diabetic?
2. Do you have any idea about her vitals like blood pressure, pulse,etc?
3. Is she on the ventilator? Or drugs to improve her blood pressure?
4. Does she have any other co mobid conditions like cholesterol, hypertension, etc?

If you could answer this then I could give a much more definitive answer. Please get back to me, I am awaiting your reply

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (10 hours later)

No she is not diabetic. Her blood pressure was high but it's being monitored. Yes, she is on a ventilator at night to improve her breathing as there is fluid stuck at the base of her lungs reducing capacity. She is on oxygen all the time. As far as I know she has no other issues except she was very obese 18 months ago and had gastric-band op. She lost about half her body weight within a year. From 23 stone to 13 stone. It did not work out because she could not digest food properly so she had it removed about 6-8 months ago. Within a few months, she developed gall stones, several small ones and one large one. The big one got into the pancreas. That's all I know. I just need to know what are her chances of recovery?

Answered by Dr. Rakesh Madhyastha (6 hours later)

Hello

Thanks for replying

Since she is a young non diabetic patient who is not on ionotropic support as of now, I would say her chances are looking good. But the fact that she requires the ventilator at night (I am thinking its NIV) is not a good sign as we might be looking at a multi organ dysfunction which is involving her lungs as well.
But on the whole I would still say her chances of survival are pretty strong at this point.

I wish her a speedy recovery

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (28 minutes later)

What is ionotropic support? Can a pancreas function if part of it needs to be removed?

Answered by Dr. Rakesh Madhyastha (6 hours later)

Hello

I am sorry I did not explain what ionotropic support was earlier. Ionotropes are drugs which increase blood pressure. The prognosis is considered worse if a patient is not maintaining his own blood pressure. It happens in severe conditions like sepsis, volume loss, etc. Some of the ionotropes are Dopamine, dobutamine and nor adrenaline. It is given as continuous infusion to help maintain blood pressure at 120/80.

Pancreas might function not function after the partial removal. The main function of the pancreas is to secrete insulin so she might have to receive insulin just like any other diabetic. She will also have to XXXXXXX endocrinologist once in 3 months to alter doses of the insulin.

Thank you

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (23 hours later)

My friend is now on the ventilator all the time. Does this mean her condition has got worse? Why has a surgeon not taken away the dead tissue yet? She is still waiting for a pancreatic drain. How significant a difference is there between the clinical definition of 'seriously ill' and 'critically ill'.?
Thank you.

Answered by Dr. Rakesh Madhyastha (55 minutes later)

Hello

Thanks for updating

If your friend is on the ventilator then she is critical. At our hospital of 90 ICU beds with 45 ventilators 3-4 patients out of 10 survive when put on the ventilator. Since your friend is young there are higher possibilities survival.
The dead necrotic tissue is probably not removed as she is not fit for surgery, once the condition stabilizes she might be taken up for the surgery.
I could help you a lot more if you get let me know the latest x XXXXXXX report and Complete blood count
Seriously ill patients are those who are in the ICU set up but not requiring ventilator or ionotropes.

I wish her a speedy recovery

Regards

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Rakesh Madhyastha (12 hours later)

Thank you doctor. I can't give you blood count. Her last CT scan showed necrosis in liver, abdomen and possibly lungs. But since her last CT scan on Monday there has been no further necrosis. It is the same as last Monday. Thanks for your information. I have no further questions. I've just been trying to prepare myself. She's my best friend, like a sister. Thanks for your help.

Answered by Dr. Rakesh Madhyastha (2 hours later)

Hello

Thanks for the update

Looks like she is having multi organ involvement. Its good news that the necrosis has seized. I am sure the doctors are doing their best to save the vital organs. I wish her good luck and a speedy recovery
If you have any further queries I will be happy to help.

Regards

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar