Which is not a feature of pancreatic ascites ?
Answer is 'a' i.e. Low protein Pancreatic ascitic fluid, contains elevated protein (> 2.9 g/dI) and amylase levels. Pancreatic ascites occurs - when pancreatic juice gains entry into the peritoneal cavity either from a pancreatic duct disruption or - from a leaking pseudocyst The principal causative factors are alcoholic pancreatitis in adults and traumatic pancreatitis in children. The diagnosis can usually be made when high amylase levels are found in the ascitic fluid. Definitive diagnosis is made by ERCP. Management The initial treatment usually is nonoperative and involves attempts to decrease pancreatic secretion by - elimination of enteral feeding - nasogastric drainage and - use of antisecretory hormone somatostatin About 50 to 60 % pts. respond to this tit. If considerably improvement does not occur within 2-3 weeks then these patients are treated either endoscopically or surgically. - Endoscopic tit involves endoscopic pancreatic sphincterotomy with or without placement of transpapillary pancreatic duct stent. By reducing the resistance to drainage into the duodenum, and by bridging the site of duct disruption, this approach is designed to allow the site of leakage to seal. Surgical treatment is usually preceded by ERCP to identify the site of duct disruption. Surgery involves resection (for leaks in the pancreatic tail) internal Roux-en- Y drainage (for leaks in the pancreatic head & neck region)
Low protein
Somatostatin is the drug of choice
Communication with pancreatic duct in 80%
Raised amylase levels